Hyperlipidemia in COPD is associated with decreased incidence of pneumonia and mortality: a nationwide health insurance data-based retrospective cohort study

Figures & data

Figure 1 Enrollment details.

Abbreviations: CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; NHIRD, National Health Insurance Research Database; LABA, long-acting beta agonists; LAMA, long-acting muscarinic antagonists; ICS, inhaled corticosteroids.

Table 1 Demographics and clinical characteristics of the study subjects

Variables	Total (n=2,982)	COPD (n=1,491)	Non-COPD (n=1,491)	P-value for χ^2 test
Age, years
40–54	578 (19.4)	289 (19.4)	289 (19.4)	1
55–64	520 (17.4)	260 (17.4)	260 (17.4)
65–74	850 (28.5)	425 (28.5)	425 (28.5)
≥75	1,034 (34.7)	517 (34.7)	517 (34.7)
Sex
Female	1,138 (38.2)	569 (38.2)	569 (38.2)	1
Male	1,844 (61.8)	922 (61.8)	922 (61.8)
CCI
0	1,060 (35.6)	530 (35.6)	530 (35.6)	1
1	748 (25.1)	374 (25.1)	374 (25.1)
2	484 (16.2)	242 (16.2)	242 (16.2)
≥3	690 (23.1)	345 (23.1)	345 (23.1)
Pneumonia
No	2,444 (82.0)	1,108 (74.3)	1,336 (89.6)	<0.0001
Yes	538 (18.0)	383 (25.7)	155 (10.4)
CVD
No	2,601 (87.2)	1,266 (84.9)	1,335 (89.5)	<0.0001
Yes	381 (12.8)	225 (15.1)	156 (10.5)
Cancer
No	2,768 (92.8)	1,379 (92.5)	1,389 (93.2)	0.478
Yes	214 (7.2)	112 (7.5)	102 (6.8)
Death
No	2,350 (78.8)	1,094 (73.4)	1,256 (84.2)	<0.0001
Yes	632 (21.2)	397 (26.6)	235 (15.8)

Note: Data are presented as n (%).

Abbreviations: CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease.

Table 2 Impact of age, sex, and CCI on major outcomes of COPD

Variables	Hazard ratio (95% CI)	P-value
Pneumonia
Age	1.57 (1.44–1.72)	<0.0001
Sex (male/female)	1.56 (1.25–1.94)	<0.0001
CCI 1 (1/0)	1.21 (0.91–1.59)	0.191
CCI 2 (2/0)	1.37 (1.02–1.84)	0.039
CCI ≥3 (≥3/0)	1.61 (1.23–2.09)	<0.0001
AECOPD
Age	1.34 (1.24–1.44)	<0.0001
Sex	1.83 (1.50–2.24)	<0.0001
CCI 1	0.91 (0.72–1.15)	0.410
CCI 2	0.92 (0.70–1.20)	0.525
CCI ≥3	1.17 (0.94–1.46)	0.171
Cardiovascular disease
Age	1.54 (1.37–1.73)	<0.0001
Sex (male/female)	1.12 (0.85–1.46)	0.425
CCI 1 (1/0)	0.97 (0.67–1.42)	0.887
CCI 2 (2/0)	1.20 (0.80–1.78)	0.378
CCI ≥3 (≥3/0)	1.73 (1.24–2.41)	0.001
Cancer
Age	1.17 (1.00–1.36)	0.044
Sex (male/female)	1.70 (1.12–2.57)	0.013
CCI 1 (1/0)	0.70 (0.42–1.17)	0.172
CCI 2 (2/0)	1.16 (0.70–1.92)	0.579
CCI ≥3 (≥3/0)	0.89 (0.54–1.47)	0.645
Mortality
Age	2.04 (1.85–2.24)	<0.0001
Sex (male/female)	1.46 (1.18–1.80)	0.001
CCI 1 (1/0)	0.83 (0.62–1.10)	0.197
CCI 2 (2/0)	1.00 (0.74–1.34)	0.988
CCI ≥3 (≥3/0)	1.43 (1.12–1.83)	0.004

Abbreviations: AECOPD, acute exacerbation of COPD; CCI, Charlson comorbidity index; CI, confidence interval; COPD, chronic obstructive pulmonary disease.

Table 3 Impacts of major comorbidities on outcomes of COPD

Variables	Hazard ratio (95% CI)	P-value
Pneumonia
Age	1.54 (1.14–1.69)	<0.0001
Sex (male/female)	1.52 (1.22–1.90)	<0.0001
Hypertension	1.11 (0.90–1.36)	0.349
Hyperlipidemia	0.68 (0.49–0.93)	0.016
Diabetes	1.37 (1.05–1.79)	0.019
Chronic renal disease	1.32 (0.92–1.89)	0.134
Cardiovascular disease	1.70 (1.02–2.88)	0.048
Oral steroids	1.04 (0.68–1.59)	0.857
Inhaled steroids	0.98 (0.79–1.20)	0.825
AECOPD
Age	1.32 (1.23–1.42)	<0.0001
Sex (male/female)	1.81 (1.48–2.21)	<0.0001
Hypertension	1.11 (0.92–1.34)	0.261
Hyperlipidemia	0.80 (0.61–1.04)	0.099
Diabetes	0.92 (0.71–1.19)	0.529
Chronic renal disease	0.87 (0.60–1.25)	0.440
Cardiovascular disease	1.01 (0.58–1.74)	0.977
Oral steroids	1.16 (0.80–1.70)	0.442
Inhaled steroids	1.11 (0.92–1.32)	0.278
Cardiovascular disease
Age	1.52 (1.35–1.72)	<0.0001
Sex (male/female)	1.16 (0.88–1.53)	0.285
Hypertension	1.47 (1.12–1.95)	0.007
Hyperlipidemia	1.09 (0.77–1.53)	0.641
Diabetes	1.66 (1.21–2.27)	0.002
Chronic renal disease	1.03 (0.63–1.68)	0.896
Oral steroids	1.27 (0.77–2.07)	0.352
Inhaled steroids	0.95 (0.72–1.24)	0.681
Malignancy
Age	1.17 (1.01–1.37)	0.043
Sex (male/female)	1.66 (1.10–2.52)	0.017
Hypertension	1.00 (0.67–1.49)	0.999
Hyperlipidemia	0.66 (0.36–1.20)	0.171
Diabetes	0.93 (0.53–1.64)	0.804
Chronic renal disease	0.86 (0.37–1.97)	0.771
Cardiovascular disease	1.04 (0.92–1.18)	0.979
Oral steroids	1.55 (0.71–3.37)	0.273
Inhaled steroids	1.03 (0.71–1.50)	0.876
Mortality
Age	1.97 (1.78–2.17)	<0.0001
Sex (male/female)	1.37 (1.11–1.70)	0.004
Hypertension	0.95 (0.77–1.16)	0.592
Hyperlipidemia	0.62 (0.44–0.87)	0.005
Diabetes	1.30 (1.00–1.70)	0.054
Chronic renal disease	1.66 (1.20–2.30)	0.002
Cardiovascular disease	1.94 (1.23–3.07)	0.005
Oral steroids	1.41 (0.98–2.02)	0.062
Inhaled steroids	0.90 (0.73–1.10)	0.306

Abbreviations: AECOPD, acute exacerbation of COPD; CI, confidence interval; COPD, chronic obstructive pulmonary disease.

Figure 2 Kaplan–Meier survival estimates for hyperlipidemia and non-hyperlipidemia in patients with COPD.

Note: Patients with COPD having hyperlipidemia are associated with better survival (P<0.05).
Abbreviation: COPD, chronic obstructive pulmonary disease.