Prevalence and Impact of Social Frailty in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background

Patients with chronic obstructive pulmonary disease (COPD) are more inclined to have a high level of social vulnerability due to their physical and psychological burden. However, to date, there have been no study on social frailty in patients with COPD. This study aimed to investigate the prevalence, characteristics, and impact of social frailty in patients with COPD.

Methods

Social frailty was assessed using five items in a questionnaire. A patient was diagnosed with social frailty if responses to two or more items were positive. Four hundred and five patients with COPD were assessed for social frailty, dyspnea, and appetite. We also prospectively examined the number of acute exacerbation and unexpected hospitalization for 1 year.

Results

Thirty-six percent of patients with COPD had social frailty. They had reduced appetite and more severe dyspnea [Simplified Nutritional Appetite Questionnaire score: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.69‒0.95, p < 0.01; modified Medical Research Council score: OR 1.42, 95% CI 1.05‒1.93, P = 0.02] than patients without social frailty. Social frailty was not a risk factor for moderate acute exacerbation of COPD but a risk factor for severe acute exacerbation and all-cause unexpected hospitalization (severe acute exacerbation: β, standardized regression coefficient: 0.13, 95% CI 0.01‒0.25, P = 0.04, unexpected hospitalization: β 0.17, 95% CI 0.05‒0.29, P = 0.01).

Conclusion

The prevalence of social frailty is 36%; however, social frailty has a marked clinical impact in patients with COPD.

Keywords:

• social frailty
• chronic obstructive pulmonary disease
• social robustness

Abbreviations

CAT, COPD assessment test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; HADS, Hospital Anxiety and Depression Scale; mMRC, modified Medical Research Council dyspnea scale; OR, odds ratio; SNAQ, Simplified Nutritional Appetite Questionnaire.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

The authors thank all the patients and the team of investigators, who took part in the study. The authors thank Hideki Inoue who collected data on the participants.

Disclosure

KH reports personal fees from AstraZeneca, Boehringer Ingelheim, Kracie Pharma, Ltd., and GlaxoSmithKline outside of the submitted work. AT reports personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, KYORIN Pharmaceutical, and Sanofi outside of the submitted work. NO reports personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, KYORIN Pharmaceutical, Novartis, and Sanofi outside of the submitted work. TH reports personal fees from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline outside of the submitted work. SS reports personal fees from AstraZeneca, GlaxoSmithKline, KYORIN Pharmaceutical, Sanofi, and Tanabe-Mitsubishi outside of the submitted work. HS reports personal fees from AstraZeneca, Boehringer Ingelheim, Kyorin Pharmaceutical, GlaxoSmithKline, Novartis, Kracie Pharma, Ltd., Gilead Sciences, Tsumura and Co, MSD K.K., and Sanofi outside of the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was supported by a Grant-in-Aid for Scientific Research (KAKENHI 21K15668).