Increased risk of peripheral arterial occlusive diseases in patients with chronic obstructive pulmonary disease: a nationwide study in Taiwan

Figures & data

Figure 1 Flowchart of subject enrollment.Abbreviations: COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusive disease.

Table 1 Demographic characteristics and comorbidities of patients with and without COPD

Variables	COPD	non-COPD	P-value	Standardized difference
	(n=51,869)	(n=51,869)
Age, years
40–49	8954(17.3)	9177(17.7)	<0.001	-
50–59	10,813(20.8)	10,648(20.5)		-
60–69	12,453(24)	12,422(24)		-
≥70	19,649(37.9)	19,622(37.8)		-
Mean (±SD)	64.3(12.8)	64.3(13.1)	0.58	0.003
Sex
Male	29,206(56.3)	28,612(55.2)	<0.001	0.023
Female	22,663(43.7)	23,257(44.8)
Comorbidities
Atrial fibrillation	3253(6.3)	3490(6.7)	0.003	0.019
Hypertension	35,607(68.6)	35,489(68.4)	0.43	0.005
Diabetes	18,157(35)	18,084(34.9)	0.635	0.003
Hyperlipidemia	23,151(44.6)	23,421(45.1)	0.093	0.01
Cerebrovascular accident	17,002(32.8)	17,150(33.1)	0.331	0.006
Liver cirrhosis	16,428(31.7)	16,728(32.3)	0.046	0.012
Result
PAOD	3155(6.1%)	2937(5.7%)	0.004	-

Abbreviations: COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusion disease; SD, standard deviation.

Table 2 Incidence of PAOD in patients with and without COPD

Characteristics	COPD (51,869)			non-COPD (51,869)			aHR (95% CI)	P
	Event	TFP(PY)	IR	Event	TFP(PY)	IR
PAOD	3155	292,658.36	107.80	2937	341,645.64	85.97	1.23(1.17–1.29)	<0.001
Age
40–49	254	51,052.52	49.75	213	61,086.77	34.87	1.4(1.16–1.679)	<0.001
50–59	486	59,428.33	81.78	433	69,975.19	61.88	1.28(1.12–1.45)	<0.001
60–69	867	71,449.14	121.35	757	82,415.74	91.85	1.27(1.15–1.4)	<0.001
70 and above	1548	110,786.74	139.73	1534	128,183.73	119.67	1.12(1.05–1.21)	0.001
Sex
Male	1776	165,561.41	107.27	1474	187,627.25	78.56	1.32(1.23–1.41)	<0.001
Female	1379	127,096.95	108.50	1463	154,018.39	94.99	1.1(1.02–1.18)	0.016
Comorbidities
Atrial fibrillation
Yes	290	19,913.61	145.63	328	23,630.81	138.80	1.01(0.864–1.19)	0.863
No	2865	272,744.74	105.04	2609	318,014.83	82.04	1.23(1.17–1.3)	<0.001
Hypertension
Yes	2695	213,140.79	126.44	2567	246,203.65	104.26	1.18(1.11–1.24)	<0.001
No	460	79,517.57	57.85	370	95,442	38.77	1.36(1.19–1.55)	<0.001
Diabetes
Yes	1556	105,695.85	147.21	1544	121,340.29	127.25	1.13(1.05–1.21)	0.001
No	1599	186,962.5	85.53	1393	220,305.36	63.23	1.29(1.2–1.38)	<0.001
Hyperlipidemia
Yes	1840	136,483.76	134.81	1780	160,303.29	111.04	1.18(1.11–1.27)	<0.001
No	1315	156,174.6	84.20	1157	181,342.35	63.80	1.25(1.16–1.35)	<0.001
Cerebrovascular accident
Yes	1574	100,691.31	156.32	1598	116,196.93	137.53	1.1(1.02–1.18)	0.007
No	1581	191,967.04	82.36	1339	225,448.71	59.39	1.33(1.24–1.43)	<0.001
Liver cirrhosis
Yes	1252	92,968.47	134.67	1213	119,570.64	101.45	1.22(1.12–1.32)	<0.001
No	1903	199,689.89	95.30	1724	222,075	77.63	1.2(1.13–1.28)	<0.001

Abbreviations: COPD, chronic obstructive pulmonary disease; TFP, total follow-up period; PY, per 10,000 person-years; IR, incident rate per 10,000 person-years; aHR, adjusted hazard ratio; PAOD, peripheral arterial occlusive disease.

Table 3 Impact of comorbidities on PAOD among COPD patients (n=55,136)

Comorbidity	Number (%)	Event	aHR (95% CI)	P-value
No comorbidity	7154(13.8)	129
Atrial fibrillation only	187(0.4)	10	2.99(1.57–5.7)	0.001
Hypertension only	5755(11.1)	209	1.98(1.59–2.5)	<0.001
Diabetes only	710(1.4)	27	2.07(1.37–3.14)	0.001
Hyperlipidemia only	1827(3.5)	42	1.28(0.9–1.81)	0.165
Cerebrovascular accident only	1048(2.0)	33	1.71(1.17–2.5)	0.006
Cirrhosis only	1792(3.5)	44	1.36(0.96–1.91)	0.082
Ischemic heart disease only	966(1.9)	34	2.19(1.48–3.24)	<0.001
≥1 comorbidity	44,715(86.2)	3026	3.7(3.1–4.41)	<0.001
≥2 comorbidities	34,667(66.8)	2682	4.22(3.53–5.04)	<0.001
≥3 comorbidities	21,907(42.2)	1963	4.9(4.01–5.85)	<0.001

Abbreviations: IR, incident rate of empyema (Event/Number); aHR, adjusted hazard ratio; COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusive disease.

Figure 2 Forest plot portraying the adjusted hazard ratio (aHR) and 95% confidence interval of the association between chronic obstructive pulmonary disease (with vs without) and peripheral arterial occlusion disease (occurred vs not occurred) in relation to having or not having comorbidities (yes vs no).

Figure 3 Cumulative incidence of peripheral arterial occlusion disease in patients with and without chronic obstructive pulmonary disease (COPD).

Figure 4 Cumulative incidence of peripheral arterial occlusion disease in patients with atrial fibrillation.Abbreviations: COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusive disease.

Figure 5 Cumulative incidence of peripheral arterial occlusion disease in patients with hypertension.Abbreviations: COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusive disease.

Figure 6 Cumulative incidence of peripheral arterial occlusion disease in patients with diabetes.Abbreviations: COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusive disease.

Figure 7 Cumulative incidence of peripheral arterial occlusion disease in patients with cerebrovascular accident.Abbreviations: COPD, chronic obstructive pulmonary disease; PAOD, peripheral arterial occlusive disease.