The Increased Burden of Morbidity Over the Life-Course Among Patients with COPD: A Register-Based Cohort Study in Sweden

Figures & data

Table 1 Risk of Diseases Prior to COPD Diagnosis

	COPD	Non-COPD	Unadjusted	Adjusted
	n=223 945	n=1062 731			Males	Females
Outcome	n (%)	n (%)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Cardiovascular
Atrial fibrillation	35,676 (15.9)	108 734 (10.2)	1.72 (1.70–1.74)	1.72 (1.70–1.75)	1.67 (1.65–1.70)	1.79 (1.76–1.83)
Cerebrovascular disease	27,130 (12.1)	96,787 (9.1)	1.40 (1.38–1.42)	1.37 (1.35–1.40)	1.31 (1.29–1.34)	1.46 (1.43–1.50)
Chronic heart failure	40,031 (17.9)	69,506 (6.5)	3.32 (3.27–3.37)	3.25 (3.20–3.30)	3.03 (2.97–3.08)	3.57 (3.50–3.65)
Ischemic heart disease	54,915 (24.5)	169 397 (15.9)	1.77 (1.75–1.79)	1.73 (1.71–1.75)	1.59 (1.57–1.61)	1.95 (1.92–1.99)
Peripheral arterial disease	22,157 (9.9)	36,179 (3.4)	3.19 (3.13–3.25)	3.12 (3.06–3.18)	2.84 (2.78–2.91)	3.59 (3.49–3.69)
Endocrine
Diabetes	27,363 (12.2)	95,926 (9.0)	1.42 (1.40–1.44)	1.37 (1.35–1.39)	1.33 (1.31–1.36)	1.42 (1.38–1.45)
Osteoporosis	9340 (4.2)	23,955 (2.3)	1.96 (1.91–2.01)	1.99 (1.94–2.04)	2.48 (2.32–2.64)	1.92 (1.86–1.97)
Gastrointestinal
Crohn’s disease	1432 (0.6)	3628 (0.3)	1.88 (1.77–2.00)	1.86 (1.75–1.98)	1.58 (1.43–1.73)	2.13 (1.96–2.31)
Ulcerative colitis	1692 (0.8)	6257 (0.6)	1.29 (1.22–1.36)	1.29 (1.22–1.36)	1.24 (1.15–1.33)	1.36 (1.25–1.47)
Liver diseases	3898 (1.7)	8861 (0.8)	2.11 (2.03–2.19)	2.07 (2.00–2.16)	2.07 (1.96–2.19)	2.08 (1.97–2.20)
Malabsorptive disorders	861 (0.4)	2976 (0.3)	1.38 (1.28–1.49)	1.40 (1.29–1.51)	1.43 (1.27–1.62)	1.37 (1.24–1.51)
Psychiatric
Bipolar disorder	2031 (0.9)	5514 (0.5)	1.76 (1.68–1.86)	1.80 (1.71–1.90)	1.65 (1.52–1.80)	1.90 (1.78–2.03)
Depression	12,422 (5.6)	33,547 (3.2)	1.82 (1.78–1.86)	1.82 (1.78–1.86)	1.72 (1.66–1.78)	1.88 (1.83–1.93)
Psychosis	3406 (1.5)	8358 (0.8)	1.95 (1.87–2.03)	1.89 (1.81–1.96)	1.82 (1.70–1.94)	1.93 (1.83–2.03)
Neurological
Dementia	5207 (2.3)	30,323 (2.9)	0.81 (0.79–0.84)	0.81 (0.78–0.83)	0.85 (0.81–0.88)	0.77 (0.74–0.81)
Epilepsy	4210 (1.9)	13,396 (1.3)	1.50 (1.44–1.55)	1.47 (1.42–1.52)	1.50 (1.44–1.58)	1.42 (1.35–1.50)
Parkinson’s disease	1455 (0.7)	9787 (0.9)	0.71 (0.67–0.75)	0.72 (0.68–0.76)	0.71 (0.66–0.76)	0.73 (0.67–0.79)
Respiratory
Asthma	33,561 (15.0)	22,172 (2.1)	8.33 (8.18–8.49)	8.31 (8.15–8.46)	8.74 (8.49–9.00)	8.02 (7.82–8.21)
Others
Chronic kidney disease	6757 (3.0)	14,801 (1.4)	2.26 (2.20–2.33)	2.21 (2.14–2.28)	2.12 (2.04–2.20)	2.40 (2.28–2.52)
Psoriasis	5938 (2.7)	15,866 (1.5)	1.82 (1.77–1.88)	1.81 (1.76–1.87)	1.70 (1.63–1.79)	1.91 (1.83–1.99)
Rheumatic disease	11,105 (5.0)	32,913 (3.1)	1.65 (1.61–1.69)	1.63 (1.60–1.67)	1.70 (1.64–1.77)	1.60 (1.56–1.64)
Cancers
Bladder	4186 (1.9)	9535 (0.9)	2.11 (2.04–2.19)	2.12 (2.04–2.20)	1.96 (1.88–2.05)	2.74 (2.54–2.96)
Brain	516 (0.2)	2904 (0.3)	0.85 (0.77–0.93)	0.85 (0.77–0.93)	0.89 (0.77–1.04)	0.82 (0.73–0.93)
Breast^a	6071 (5.4)	25,337 (4.8)	1.15 (1.11–1.18)	1.18 (1.15–1.22)		1.18 (1.15–1.22)
Cervical^a	269 (0.2)	817 (0.2)	1.59 (1.38–1.82)	1.56 (1.35–1.79)		1.56 (1.35–1.79)
Colorectal	4938 (2.2)	19,540 (1.8)	1.21 (1.17–1.25)	1.21 (1.18–1.25)	1.22 (1.17–1.28)	1.20 (1.14–1.26)
Endometrial^a	1079 (1.0)	7413 (1.4)	0.69 (0.65–0.74)	0.70 (0.65–0.74)		0.70 (0.65–0.74)
Kidney	1090 (0.5)	3532 (0.3)	1.47 (1.38–1.58)	1.47 (1.38–1.58)	1.49 (1.36–1.63)	1.45 (1.30–1.62)
Leukaemia	1871 (0.8)	6110 (0.6)	1.47 (1.39–1.54)	1.48 (1.41–1.56)	1.55 (1.45–1.66)	1.39 (1.28–1.51)
Liver	172 (0.1)	294 (<0.1)	2.76 (2.28–3.34)	2.77 (2.29–3.36)	2.84 (2.23–3.60)	2.65 (1.92–3.66)
Lung	6242 (2.8)	2354 (0.2)	13.00 (12.38–13.65)	12.73 (12.12–13.37)	11.81 (11.03–12.63)	13.80 (12.84–14.82)
Lymphoma	1239 (0.6)	4546 (0.4)	1.30 (1.22–1.39)	1.31 (1.23–1.40)	1.29 (1.18–1.40)	1.34 (1.22–1.48)
Melanoma	1244 (0.6)	8538 (0.8)	0.69 (0.65–0.73)	0.72 (0.68–0.77)	0.69 (0.64–0.75)	0.76 (0.70–0.83)
Oesophagus	369 (0.2)	352 (<0.1)	4.90 (4.23–5.68)	4.80 (4.14–5.58)	4.67 (3.92–5.57)	5.16 (3.89–6.84)
Oral	1414 (0.6)	3114 (0.3)	2.18 (2.04–2.32)	2.16 (2.02–2.30)	2.20 (2.03–2.37)	2.07 (1.84–2.32)
Ovarian^a	365 (0.3)	1878 (0.4)	0.92 (0.82–1.03)	0.92 (0.82–1.03)		0.92 (0.82–1.03)
Pancreas	190 (0.1)	439 (<0.1)	2.05 (1.73–2.43)	2.06 (1.73–2.45)	1.87 (1.44–2.42)	2.24 (1.77–2.82)
Prostate^b	8805 (7.9)	42,368 (8.0)	0.99 (0.97–1.01)	1.01 (0.99–1.04)	1.01 (0.99–1.04)
Stomach	565 (0.3)	1383 (0.1)	1.96 (1.78–2.16)	1.91 (1.73–2.11)	1.89 (1.67–2.14)	1.95 (1.64–2.31)

Notes: ORs were calculated using conditional logistic regression models, controlling for matched variables (birthyear, sex and county of residence in matching year). In the adjusted analyses, highest attained level of education was included as covariate. ^aOnly female cases and controls. ^bOnly male cases and controls.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 2 Risk of Diseases Prior to COPD Diagnosis by Age

Outcome	Diseases Prior to Age 50 Years			Diseases Prior to Age 65 Years			Diseases Prior to Age 75 Years
	COPD n (%)	Non-COPD n (%)	Adjusted OR (95% CI)	COPD n (%)	Non-COPD n (%)	Adjusted OR (95% CI)	COPD n (%)	Non-COPD n (%)	Adjusted OR (95% CI)
Cardiovascular
Atrial fibrillation	258 (0.1)	655 (0.1)	1.92 (1.65–2.22)	6427 (2.9)	17,251 (1.6)	1.80 (1.75–1.86)	20,995 (9.4)	60,349 (5.7)	1.75 (1.72–1.77)
Cerebrovascular disease	383 (0.2)	835 (0.1)	2.11 (1.86–2.38)	6862 (3.1)	17,665 (1.7)	1.83 (1.78–1.89)	17,951 (8.0)	55,586 (5.2)	1.56 (1.53–1.58)
Chronic heart failure	178 (0.1)	155 (<0.1)	5.20 (4.17–6.49)	6330 (2.8)	7356 (0.7)	4.07 (3.92–4.21)	21,486 (9.6)	30,972 (2.9)	3.49 (3.43–3.56)
Ischemic heart disease	1359 (0.6)	2364 (0.2)	2.66 (2.49–2.85)	18,775 (8.4)	49,024 (4.6)	1.87 (1.84–1.91)	40,676 (18.2)	120 143 (11.3)	1.73 (1.71–1.75)
Peripheral arterial disease	245 (0.1)	253 (<0.1)	4.44 (3.71–5.32)	4943 (2.2)	6128 (0.6)	3.78 (3.64–3.93)	15,016 (6.7)	21,186 (2.0)	3.50 (3.42–3.58)
Endocrine
Diabetes	711 (0.3)	1534 (0.1)	2.10 (1.92–2.30)	9065 (4.1)	25,368 (2.4)	1.67 (1.63–1.72)	20,325 (9.1)	66,164 (6.2)	1.46 (1.44–1.49)
Osteoporosis	16 (<0.1)	22 (<0.1)	3.40 (1.76–6.58)	1367 (0.6)	2888 (0.3)	2.31 (2.16–2.46)	5200 (2.3)	11,945 (1.1)	2.17 (2.10–2.25)
Gastrointestinal
Crohn’s disease	166 (0.1)	352 (<0.1)	2.17 (1.80–2.62)	795 (0.4)	1897 (0.2)	1.96 (1.80–2.13)	1253 (0.6)	3039 (0.3)	1.93 (1.81–2.07)
Ulcerative colitis	127 (0.1)	491 (0.1)	1.26 (1.03–1.53)	737 (0.3)	2908 (0.3)	1.21 (1.11–1.31)	1382 (0.6)	5170 (0.5)	1.27 (1.19–1.35)
Liver diseases	270 (0.1)	446 (<0.1)	2.79 (2.39–3.26)	1980 (0.9)	3874 (0.4)	2.38 (2.25–2.51)	3360 (1.5)	7160 (0.7)	2.20 (2.11–2.30)
Malabsorptive disorders	38 (<0.1)	93 (<0.1)	1.97 (1.35–2.89)	367 (0.2)	1123 (0.1)	1.56 (1.38–1.76)	703 (0.3)	2346 (0.2)	1.45 (1.33–1.58)
Psychiatric
Bipolar disorder	434 (0.2)	688 (0.1)	3.00 (2.65–3.39)	1387 (0.6)	3091 (0.3)	2.18 (2.04–2.32)	1879 (0.8)	4779 (0.5)	1.92 (1.82–2.03)
Depression	929 (0.4)	1384 (0.1)	3.18 (2.92–3.46)	5323 (2.4)	11,258 (1.1)	2.29 (2.22–2.37)	9388 (4.2)	22,876 (2.2)	2.00 (1.95–2.05)
Psychosis	798 (0.4)	1118 (0.1)	3.31 (3.01–3.63)	2295 (1.0)	4340 (0.4)	2.43 (2.30–2.55)	3029 (1.4)	6626 (0.6)	2.10 (2.01–2.19)
Neurological
Dementia	9 (<0.1)	17 (<0.1)	2.57 (1.12–5.91)	344 (0.2)	955 (0.1)	1.64 (1.44–1.86)	1648 (0.7)	8195 (0.8)	0.93 (0.88–0.99)
Epilepsy	346 (0.2)	584 (0.1)	2.56 (2.24–2.93)	1997 (0.9)	4498 (0.4)	2.02 (1.91–2.13)	3352 (1.5)	9432 (0.9)	1.64 (1.58–1.71)
Parkinson’s disease	6 (<0.1)	28 (<0.1)	1.15 (0.47–2.83)	179 (0.1)	1213 (0.1)	0.69 (0.59–0.81)	798 (0.4)	5329 (0.5)	0.72 (0.67–0.77)
Respiratory
Asthma	1373 (0.6)	767 (0.1)	8.10 (7.40–8.87)	11,623 (5.2)	7350 (0.7)	7.80 (7.56–8.04)	24,467 (10.9)	16,259 (1.5)	7.90 (7.73–8.07)
Others
Chronic kidney disease	29 (<0.1)	45 (<0.1)	2.90 (1.80–4.66)	691 (0.3)	1361 (0.1)	2.33 (2.12–2.56)	3116 (1.4)	6088 (0.6)	2.40 (2.30–2.51)
Psoriasis	147 (0.1)	235 (<0.1)	2.69 (2.18–3.31)	2206 (1.0)	5514 (0.5)	1.89 (1.80–1.99)	4811 (2.2)	12,428 (1.2)	1.86 (1.80–1.93)
Rheumatic disease	427 (0.2)	819 (0.1)	2.43 (2.16–2.74)	4011 (1.8)	9791 (0.9)	1.94 (1.86–2.01)	8124 (3.6)	22,358 (2.1)	1.74 (1.70–1.79)
Cancers
Bladder	43 (<0.1)	100 (<0.1)	2.06 (1.43–2.97)	930 (0.4)	2089 (0.2)	2.09 (1.94–2.27)	2740 (1.2)	6058 (0.6)	2.14 (2.05–2.24)
Brain	33 (<0.1)	141 (<0.1)	1.12 (0.76–1.64)	235 (0.1)	1333 (0.1)	0.84 (0.73–0.97)	439 (0.2)	2489 (0.2)	0.84 (0.76–0.93)
Breast ^a	258 (0.2)	1025 (0.2)	1.22 (1.06–1.40)	2561 (2.3)	11,021 (2.1)	1.14 (1.09–1.19)	4952 (4.4)	21,103 (4.0)	1.15 (1.12–1.19)
Cervical ^a	27 (<0.1)	105 (<0.1)	1.17 (0.76–1.79)	129 (0.1)	408 (0.1)	1.48 (1.21–1.80)	219 (0.2)	665 (0.1)	1.55 (1.33–1.81)
Colorectal	41 (<0.1)	152 (<0.1)	1.29 (0.91–1.84)	911 (0.4)	3960 (0.4)	1.10 (1.03–1.19)	3040 (1.4)	12,236 (1.2)	1.18 (1.14–1.23)
Endometrial ^a	26 (<0.1)	144 (<0.1)	0.86 (0.57–1.32)	396 (0.4)	2770 (0.5)	0.68 (0.61–0.76)	849 (0.8)	5821 (1.1)	0.70 (0.65–0.75)
Kidney	12 (<0.1)	60 (<0.1)	0.96 (0.51–1.81)	276 (0.1)	986 (0.1)	1.31 (1.14–1.50)	787 (0.4)	2530 (0.2)	1.48 (1.36–1.60)
Leukaemia	20 (<0.1)	64 (<0.1)	1.57 (0.94–2.61)	424 (0.2)	1231 (0.1)	1.69 (1.51–1.89)	1219 (0.5)	3772 (0.4)	1.57 (1.47–1.68)
Liver	0 (0)	0 (0)	-	17 (<0.1)	36 (<0.1)	2.14 (1.19–3.85)	109 (0.1)	155 (<0.1)	3.24 (2.52–4.15)
Lung	27 (<0.1)	15 (<0.1)	9.63 (4.83–19.20)	1049 (0.5)	453 (<0.1)	10.52 (9.39–11.78)	4162 (1.9)	1548 (0.2)	12.73 (11.98–13.52)
Lymphoma	35 (<0.1)	85 (<0.1)	1.98 (1.33–2.96)	377 (0.2)	1240 (0.1)	1.44 (1.28–1.62)	895 (0.4)	3115 (0.3)	1.37 (1.27–1.48)
Melanoma	42 (<0.1)	348 (<0.1)	0.60 (0.43–0.83)	387 (0.2)	2931 (0.3)	0.65 (0.59–0.73)	857 (0.4)	6271 (0.6)	0.67 (0.63–0.72)
Oesophagus	2 (<0.1)	0 (0)	-	66 (<0.1)	59 (<0.1)	5.29 (3.67–7.61)	253 (0.1)	228 (<0.1)	5.00 (4.16–6.01)
Oral	29 (<0.1)	47 (<0.1)	2.83 (1.76–4.54)	439 (0.2)	910 (0.1)	2.28 (2.03–2.56)	1075 (0.5)	2239 (0.2)	2.27 (2.11–2.44)
Ovarian^a	21 (<0.1)	98 (<0.1)	1.05 (0.65–1.69)	164 (0.2)	810 (0.2)	0.94 (0.79–1.11)	303 (0.3)	1543 (0.3)	0.92 (0.81–1.04)
Pancreas	0 (0)	4 (<0.1)	-	24 (<0.1)	69 (<0.1)	1.61 (1.00–2.57)	115 (0.1)	276 (<0.1)	1.99 (1.59–2.48)
Prostate^b	0 (0)	7 (<0.1)	-	1356 (1.2)	6628 (1.3)	1.02 (0.96–1.08)	5727 (5.1)	27,985 (5.3)	1.00 (0.97–1.03)
Stomach	6 (<0.1)	14 (<0.1)	1.91 (0.73–5.04)	107 (0.1)	299 (<0.1)	1.60 (1.28–2.00)	353 (0.2)	858 (0.1)	1.90 (1.67–2.15)

Notes: ORs were calculated using conditional logistic regression models, controlling for matched variables (birthyear, sex and county of residence in matching year) and adjusted for highest attained level of education. Only morbidity occurring prior to index date and prior to age 50, 65 or 75 years respectively was included in analyses. ^aOnly female cases and controls. ^bOnly male cases and controls.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 3 Risk of Comorbid Disease After COPD Diagnosis

	No of Outcome Events	No of Individuals^a	Unadjusted	Adjusted
					Males	Females
Outcome	n	n	HR (95% CI)	HR (95% CI)	HR (95% CI)	HR (95% CI)
Cardiovascular
Atrial fibrillation	506 790	2626 114	1.95 (1.93–1.98)	1.90 (1.88–1.93)	1.83 (1.80–1.86)	2.02 (1.99–2.06)
Cerebrovascular disease	445 626	2615 538	1.46 (1.44–1.48)	1.42 (1.40–1.44)	1.33 (1.30–1.35)	1.56 (1.53–1.59)
Chronic heart failure	472 598	2635 423	3.63 (3.60–3.67)	3.50 (3.46–3.53)	3.13 (3.09–3.18)	4.02 (3.97–4.08)
Ischemic heart disease	520 916	2510 244	2.08 (2.05–2.10)	2.02 (2.00–2.05)	1.82 (1.79–1.86)	2.32 (2.28–2.36)
Peripheral arterial disease	199 246	2676 447	2.87 (2.82–2.91)	2.75 (2.70–2.79)	2.47 (2.41–2.52)	3.19 (3.12–3.27)
Endocrine
Diabetes	366 794	2623 067	1.44 (1.41–1.46)	1.39 (1.37–1.42)	1.35 (1.31–1.38)	1.48 (1.44–1.51)
Osteoporosis	143 938	2697 832	3.15 (3.09–3.20)	3.35 (3.30–3.42)	4.41 (4.24–4.59)	3.14 (3.08–3.20)
Gastrointestinal
Crohn’s disease	10,061	2702 662	2.54 (2.34–2.76)	2.48 (2.28–2.70)	2.08 (1.83–2.38)	2.83 (2.54–3.16)
Ulcerative colitis	17,507	2701 214	2.01 (1.88–2.16)	2.01 (1.87–2.15)	1.84 (1.66–2.04)	2.17 (1.98–2.39)
Liver diseases	45,202	2695 624	2.64 (2.54–2.74)	2.51 (2.42–2.61)	2.39 (2.27–2.52)	2.64 (2.50–2.79)
Malabsorptive disorders	10,777	2705 051	1.83 (1.67–2.01)	1.88 (1.72–2.06)	1.82 (1.59–2.10)	1.89 (1.68–2.13)
Psychiatric
Bipolar disorder	11,383	2696 563	1.68 (1.53–1.84)	1.71 (1.55–1.88)	1.59 (1.36–1.86)	1.80 (1.60–2.03)
Depression	138 674	2672 963	2.61 (2.56–2.67)	2.58 (2.53–2.64)	2.54 (2.46–2.63)	2.61 (2.54–2.68)
Psychosis	20,868	2688 358	1.74 (1.63–1.86)	1.69 (1.59–1.81)	1.76 (1.59–1.96)	1.66 (1.53–1.80)
Neurological
Dementia	259 137	2689 815	1.36 (1.34–1.38)	1.32 (1.30–1.35)	1.31 (1.28–1.34)	1.34 (1.31–1.37)
Epilepsy	57,109	2691 131	1.72 (1.66–1.79)	1.66 (1.59–1.72)	1.62 (1.54–1.71)	1.71 (1.61–1.81)
Parkinson’s disease	45,796	2699 274	0.73 (0.69–0.77)	0.71 (0.67–0.76)	0.73 (0.67–0.78)	0.69 (0.62–0.76)
Respiratory
Asthma	107 742	2673 236	6.58 (6.46–6.70)	6.62 (6.50–6.74)	6.77 (6.58–6.97)	6.48 (6.33–6.63)
Others
Chronic kidney disease	150 665	2702 633	3.29 (3.23–3.34)	3.07 (3.02–3.12)	2.75 (2.69–2.81)	3.70 (3.60–3.80)
Psoriasis	61,655	2701 412	2.00 (1.93–2.08)	1.98 (1.91–2.05)	1.86 (1.76–1.97)	2.06 (1.96–2.17)
Rheumatic disease	125 965	2680 907	1.68 (1.63–1.72)	1.70 (1.65–1.74)	1.71 (1.64–1.78)	1.68 (1.62–1.73)
Cancers
Bladder	39,262	2698 309	2.09 (2.01–2.18)	1.96 (1.88–2.04)	1.89 (1.80–1.98)	2.18 (2.01–2.36)
Brain^b	5885	1793 722	1.34 (1.10–1.64)	1.36 (1.12–1.66)	1.00 (0.71–1.43)	1.63 (1.28–2.07)
Breast	74,489	1411 074	1.14 (1.09–1.19)	1.14 (1.09–1.19)		1.14 (1.09–1.19)
Cervical	3120	1438 287	1.87 (1.59–2.21)	1.84 (1.56–2.16)		1.84 (1.56–2.16)
Colorectal	91,027	2690 827	1.38 (1.33–1.42)	1.36 (1.31–1.40)	1.31 (1.26–1.37)	1.41 (1.34–1.47)
Endometrial	22,263	1432 571	0.65 (0.59–0.72)	0.66 (0.59–0.72)		0.66 (0.59–0.72)
Kidney	16,581	2703 280	1.65 (1.54–1.78)	1.62 (1.50–1.74)	1.50 (1.36–1.65)	1.81 (1.62–2.01)
Leukaemia	36,340	2701 753	1.38 (1.31–1.45)	1.34 (1.28–1.41)	1.34 (1.25–1.43)	1.34 (1.24–1.45)
Liver	7952	2706 685	2.36 (2.17–2.58)	2.23 (2.05–2.43)	2.17 (1.95–2.42)	2.34 (2.03–2.71)
Lung	57,585	2704 570	6.35 (6.21–6.50)	6.04 (5.90–6.18)	5.09 (4.93–5.26)	7.20 (6.96–7.44)
Lymphoma	23,396	2702 496	1.35 (1.26–1.44)	1.32 (1.24–1.41)	1.27 (1.16–1.39)	1.39 (1.26–1.53)
Melanoma^c	20,341	2464 853	0.79 (0.72–0.87)	0.80 (0.72–0.88)	0.76 (0.66–0.87)	0.85 (0.73–0.98)
Oesophagus	6595	2706 577	2.88 (2.63–3.15)	2.67 (2.44–2.92)	2.66 (2.39–2.95)	2.74 (2.31–3.25)
Oral	13,874	2703 304	2.27 (2.12–2.44)	2.14 (1.99–2.29)	2.08 (1.91–2.27)	2.25 (2.01–2.53)
Ovarian	9024	1437 013	1.08 (0.95–1.22)	1.07 (0.94–1.22)		1.07 (0.94–1.22)
Pancreas	16,225	2706 586	1.90 (1.78–2.04)	1.88 (1.76–2.01)	1.80 (1.63–1.99)	1.96 (1.79–2.15)
Prostate	146 473	1245 767	0.94 (0.91–0.97)	0.94 (0.91–0.97)	0.94 (0.91–0.97)
Stomach	14,116	2705 278	1.58 (1.46–1.70)	1.50 (1.39–1.62)	1.50 (1.37–1.65)	1.48 (1.30–1.69)
Cause of death
Cancer	384 729	2706 814	3.34 (3.30–3.37)	3.22 (3.19–3.26)	2.97 (2.93–3.01)	3.51 (3.46–3.57)
Cardiovascular	761 203	2706 814	3.75 (3.72–3.77)	3.62 (3.59–3.64)	3.37 (3.34–3.40)	4.03 (3.99–4.07)
Respiratory	298 988	2706 814	12.49 (12.39–12.59)	11.98 (11.88–12.07)	9.93 (9.82–10.04)	15.04 (14.87–15.22)

Notes: Cox regressions with COPD diagnosis being modelled as a time-varying covariate. The adjusted HRs were obtained by controlling for sex, highest attained level of education and county of residence in 1997. ^aNumber of individuals in analysis after exclusion due to diagnosis of outcome disease prior to 1997. ^bTruncated at 70 years. ^cTruncated at 80 years.

Abbreviations: HR, hazard ratio; CI, confidence interval.

Table 4 Risk of Disease After COPD Diagnosis by Age

	Follow-Up Until 65 Years			Follow-Up Until 75 Years
Outcome	No of Outcome Events	No of Individuals^a	Adjusted HR (95% CI)	No of Outcome Events	No of Individuals^a	Adjusted HR (95% CI)
Cardiovascular
Atrial fibrillation	37,304	1407 563	3.25 (3.04–3.47)	185 378	2118 357	2.38 (2.33–2.43)
Cerebrovascular disease	39,834	1403 424	2.66 (2.48–2.85)	165 973	2110 948	1.93 (1.89–1.98)
Chronic heart failure	26,037	1412 485	9.14 (8.70–9.60)	134 318	2128 441	5.56 (5.46–5.66)
Ischemic heart disease	74,187	1371 326	3.34 (3.18–3.51)	243 322	2037 862	2.47 (2.42–2.52)
Peripheral arterial disease	17,767	1414 416	4.56 (4.23–4.93)	85,138	2140 266	3.56 (3.47–3.65)
Endocrine
Diabetes	59,650	1415 814	2.40 (2.26–2.55)	197 673	2104 327	1.73 (1.68–1.77)
Osteoporosis	10,255	1420 283	7.36 (6.81–7.95)	51,158	2154 727	4.92 (4.78–5.06)
Gastrointestinal
Crohn’s disease	2871	1418 475	2.71 (2.08–3.53)	6722	2154 297	2.54 (2.26–2.86)
Ulcerative colitis	4932	1417 987	1.80 (1.41–2.30)	11,731	2153 356	2.11 (1.91–2.32)
Liver diseases	10,054	1415 112	3.71 (3.30–4.16)	28,372	2148 694	3.08 (2.92–3.24)
Malabsorptive disorders	2707	1420 257	2.36 (1.79–3.11)	7082	2156 524	2.13 (1.88–2.41)
Psychiatric
Bipolar disorder	3395	1415 355	2.86 (2.27–3.60)	7792	2149 444	2.25 (2.00–2.53)
Depression	22,859	1407 247	4.04 (3.74–4.36)	66,480	2134 806	3.40 (3.29–3.51)
Psychosis	4747	1411 748	2.92 (2.41–3.54)	11,222	2144 039	2.25 (2.05–2.47)
Neurological
Dementia	4456	1420 137	2.89 (2.42–3.45)	45,231	2153 371	1.88 (1.80–1.96)
Epilepsy	9574	1414 243	2.94 (2.57–3.37)	28,545	2146 434	2.21 (2.08–2.34)
Parkinson’s disease	3225	1420 266	1.04 (0.72–1.50)	18,958	2154 605	0.80 (0.72–0.89)
Respiratory
Asthma	18,176	1410 189	12.46 (11.78–13.18)	58,334	2135 786	7.46 (7.26–7.66)
Others
Chronic kidney disease	7226	1419 641	5.57 (5.00–6.21)	44,038	2155 073	4.08 (3.95–4.22)
Psoriasis	16,265	1418 611	2.50 (2.24–2.79)	43,166	2153 725	2.11 (2.01–2.22)
Rheumatic disease	18,928	1411 635	2.11 (1.89–2.36)	61,170	2139 596	1.92 (1.84–2.00)
Cancers
Bladder	4022	1419 187	2.77 (2.25–3.41)	17,902	2152 841	2.10 (1.96–2.25)
Brain	3354	1419 559	1.54 (1.12–2.12)	^b	^b	^b
Breast	17,748	699 689	1.26 (1.09–1.46)	47,291	1089 057	1.17 (1.10–1.24)
Cervical	635	710 792	2.21 (1.25–3.92)	1670	1109 087	2.23 (1.76–2.83)
Colorectal	9572	1417 791	1.25 (1.03–1.52)	41,518	2149 123	1.42 (1.34–1.50)
Endometrial	4027	709 194	0.83 (0.57–1.19)	12,841	1105 030	0.64 (0.55–0.75)
Kidney	2559	1419 996	2.85 (2.20–3.69)	9589	2155 492	1.91 (1.72–2.11)
Leukaemia	4117	1419 620	1.89 (1.47–2.43)	17,085	2154 646	1.50 (1.38–1.64)
Liver	861	1421 007	3.68 (2.52–5.38)	3946	2157 745	2.82 (2.48–3.21)
Lung	8296	1420 284	10.00 (9.24–10.82)	33,072	2156 149	6.99 (6.77–7.22)
Lymphoma	3170	1419 474	1.48 (1.07–2.04)	11,691	2154 866	1.44 (1.29–1.60)
Melanoma	4285	1418 085	0.96 (0.67–1.37)	14,731	2152 773	0.77 (0.68–0.88)
Oesophagus	957	1420 975	5.60 (4.14–7.58)	3577	2157 669	3.51 (3.09–3.99)
Oral	2523	1419 931	2.51 (1.90–3.30)	7974	2155 490	2.54 (2.30–2.81)
Ovarian	2175	710 315	1.04 (0.66–1.63)	5722	1108 092	1.11 (0.93–1.33)
Pancreas	2098	1420 948	3.42 (2.65–4.42)	8806	2157 656	2.27 (2.06–2.51)
Prostate	19,752	707 532	1.11 (0.96–1.29)	85,744	1037 740	0.98 (0.94–1.03)
Stomach	1604	1420 701	3.23 (2.37–4.39)	6278	2156 979	1.84 (1.62–2.09)
Cause of death
Cancer	31,411	1421 045	5.99 (5.70–6.31)	139 658	2157 831	4.61 (4.53–4.70)
Cardiovascular	29,152	1421 045	9.86 (9.44–10.29)	155 918	2157 831	6.48 (6.39–6.58)
Respiratory	10,932	1421 045	38.29 (36.63–40.03)	66,790	2157 831	23.06 (22.69–23.44)

Notes: Cox regressions with COPD diagnosis being modelled as a time-varying covariate. Adjusted HRs were obtained by controlling for sex, highest attained level of education and county of residence in 1997. Follow-up until 65 years and 75 years. ^aNumber of individuals in analysis after exclusion due to diagnosis of outcome disease prior to 1997. ^bBrain cancer was not truncated at age 75 years due to violation of the proportional hazards assumption after age 70.

Abbreviations: HR, hazard ratio; CI, confidence interval.

Data Sharing Statement

The data underlying this study cannot be shared publicly due to regulations under the relevant Swedish laws. Researchers who are interested in Swedish register data can refer to https://www.registerforskning.se/en/. Inquiries about the data used for this study can be addressed to the corresponding author.