Disease Progression and Age as Factors Underlying Multimorbidity in Patients with COPD: Results from COSYCONET

Figures & data

Table 1 Characteristics of the Primary Study Population at Visit 1

Characteristic	Patients n = 878
Demographics
Age [y]	63.7 ± 8.2
Sex [m/f]	519 (59.1%)/359 (40.9%)
BMI [kg/m^2]	26.7 ± 4.9
Active smoking status	194 (22.1%)
Packyears*	57 ± 34
COPD characteristics
Exacerbations, GOLD C or D [present]	270 (30.8%)
Symptoms, GOLD B or D [present]	332 (37.9%)
VAS of EQ-5D-3L [points]	60.2 ± 19.3
FEV1 [% predicted GLI]	57.4 ± 18.1

Notes: Data are given as mean ± standard deviation, or number (percentage). Groups with high symptoms (B or D) or with high exacerbation (C or D) were defined according to Global Initiative for Chronic Obstructive Lung Disease criteria; *Packyears in smokers and ex-smokers.

Abbreviations: VAS of EQ-5D-3L, visual analog scale of the EQ-5D-3L questionnaire; FEV₁, forced expiratory volume in 1 second; GLI, Global Lung Function Initiative.

Table 2 Comorbidities of the Primary Study Population at Visit 1

Comorbidity	Patients n = 878
Heart failure	41 (4.7%)
CAD	123 (14.0%)
PAD	92 (10.5%)
Hypertension	445 (50.7%)
Sleep apnea	99 (11.3%)
Hyperlipidemia	342 (39.0%)
Diabetes mellitus	86 (9.8%)
Osteoporosis	133 (15.1%)
Hyperuricemia	133 (15.1%)

Notes: Data are given as number (percentage); the presence of comorbidities was assessed from patients’ reports of physician-based diagnoses.

Abbreviations: CAD, coronary artery disease; PAD, peripheral artery disease.

Figure 1 Prevalence of comorbidities over the study visits 1 to 5, scheduled at enrolment and follow-up after 6, 18, 36 and 54 months, respectively. Data refer to patients with all four follow-up visits.

Abbreviations: CAD, coronary artery disease; PAD, peripheral artery disease.

Table 3 Results from Generalized Logistic Models with Repeated-Measures Design and Logit Link

		Dependent
Predictor		Heart Failure	CAD	PAD	Hypertension	Sleep Apnea	Hyperlipidemia	Diabetes Mellitus	Osteoporosis	Hyperuricemia
Visit 2	Estimate	0.207	0.016	0.058	0.056	0.140	0.177	0.170	0.071	0.106
	p value	0.007	0.461	0.125	0.007	0.001	<0.001	<0.001	0.013	0.002
Visit 3	Estimate	0.333	0.096	0.108	0.104	0.264	0.245	0.250	0.113	0.219
	p value	0.002	0.023	0.048	0.001	<0.001	<0.001	<0.001	0.009	<0.001
Visit 4	Estimate	0.526	0.129	0.133	0.134	0.334	0.344	0.314	0.236	0.320
	p value	<0.001	0.031	0.061	0.002	<0.001	<0.001	<0.001	<0.001	<0.001
Visit 5	Estimate	0.654	0.197	0.152	0.129	0.430	0.380	0.358	0.330	0.454
	p value	<0.001	0.009	0.075	0.017	<0.001	<0.001	0.001	<0.001	<0.001
Age	Estimate	0.255	0.263	0.341	0.216	0.048	0.161	0.172	0.124	0.101
	p value	0.001	<0.001	<0.001	<0.001	0.411	<0.001	0.020	0.019	0.059
Female	Estimate	−0.361	−0.886	−0.218	−0.279	−0.802	−0.067	−0.960	1.295	−1.070
	p value	0.209	<0.001	0.307	0.042	<0.001	0.621	<0.001	<0.001	<0.001
BMI	Estimate	−0.039	0.059	0.053	0.060	0.306	0.055	0.139	−0.013	0.177
	p value	0.692	0.359	0.336	0.211	<0.001	0.224	0.013	0.783	0.002
Smoking	Estimate	−0.121	0.061	0.106	−0.098	−0.013	0.086	−0.124	−0.057	−0.055
	p value	0.591	0.581	0.506	0.177	0.925	0.156	0.424	0.523	0.662
Exacerbations	Estimate	0.126	0.129	−0.106	0.006	−0.010	0.037	−0.033	0.054	0.048
	p value	0.124	0.008	0.018	0.837	0.814	0.285	0.590	0.247	0.298
Symptoms	Estimate	0.164	0.105	0.091	0.023	0.067	0.002	−0.030	−0.023	0.062
	p value	0.133	0.042	0.098	0.604	0.217	0.967	0.459	0.643	0.207
VAS of EQ-5D-3L	Estimate	−0.196	−0.030	−0.075	−0.017	−0.052	−0.012	0.056	0.029	−0.020
	p value	0.003	0.250	0.024	0.350	0.079	0.588	0.158	0.269	0.535
FEV₁ %predicted	Estimate	−0.050	0.009	−0.051	−0.005	0.030	0.040	−0.009	−0.024	0.044
	p value	0.318	0.709	0.046	0.848	0.280	0.031	0.854	0.346	0.276

Notes: Dependent variables are given in the headline and the results for the set of predictors in the corresponding columns below. Estimates (regression coefficients for logit link), 95% confidence intervals (95% CI) and p values are given. The coefficients for visits are relative to the values at visit 1. Odds ratios can be computed by exponentiation (base e) of the coefficients. Exacerbations refer to GOLD CD versus AB, symptoms to GOLD BD versus AC, smoking to active versus never or ex-smoker. The other regression coefficients refer to age per 5 years, BMI per 5 kg/m², VAS per 20 units and FEV₁% predicted per 10% change. The results of the table are illustrated in Figure 2. P values of statistically significant associations (p<0.05) are marked in bold face.

Abbreviations: CAD, coronary artery disease; PAD, peripheral artery disease; VAS of EQ-5D-3L, visual analog scale of the EQ-5D 3L questionnaire; FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 2 Results from generalized logistic regression models for the prevalence of comorbidities. Dependent variables are given in the headline and estimated regression coefficients in the columns. The effects of age are given per 5 years, of BMI per 5 units, of VAS per 20 units, and of FEV₁ per 10% predicted. Scales are different among comorbidities. Significance levels are denoted as follows: ⁺p<0.05, ⁺⁺p<0.01 and ⁺⁺⁺p<0.001. Data refer to patients with all four follow-up visits, and numerical values are given in Table 3 (further details are given in Supplemental Table S1).

Abbreviations: CAD, coronary artery disease; PAD, peripheral artery disease; HLP, hyperlipidemia; VAS, EQ-5D-3L Visual Analog Scale; FEV₁, forced expiratory volume in 1 second.