Sociodemographic and Geographic Risk Factors for All-Cause Mortality in Patients with COPD

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. Identifying both individual and community risk factors associated with higher mortality is essential to improve outcomes. Few population-based studies of mortality in COPD include both individual characteristics and community risk factors. Objective We used geocoded, patient-level data to describe the associations between individual demographics, neighborhood socioeconomic status, and all-cause mortality. Methods We performed a nationally representative retrospective cohort analysis of all patients enrolled in the Veteran Health Administration with at least one ICD-9 or ICD-10 code for COPD in 2016–2019. We obtained demographic characteristics, comorbidities, and geocoded residential address. Area Deprivation Index and rurality were classified using individual geocoded residential addresses. We used logistic regression models to assess the association between these characteristics and age-adjusted all-cause mortality. Results Of 1,106,163 COPD patients, 33.4% were deceased as of January 2021. In age-adjusted models, having more comorbidities, Black/African American race (OR 1.09 [95% CI: 1.08–1.11]), and higher neighborhood disadvantage (OR 1.30 [95% CI: 1.28–1.32]) were associated with all-cause mortality. Female sex (OR 0.67 [95% CI: 0.65–0.69]), Asian race (OR 0.64, [95% CI: 0.59–0.70]), and living in a more rural area were associated with lower odds of all-cause mortality. After adjusting for age, comorbidities, neighborhood socioeconomic status, and rurality, the association with Black/African American race reversed. Conclusion All-cause mortality in COPD patients is disproportionately higher in patients living in poorer neighborhoods and urban areas, suggesting the impact of social determinants of health on COPD outcomes. Black race was associated with higher age-adjusted all-cause mortality, but this association was abrogated after adjusting for gender, socioeconomic status, comorbidities, and urbanicity. Future studies should focus on exploring mechanisms by which disparities arise and developing interventions to address these.

Association Between C-Reactive Protein and Albumin Ratios and Risk of Mortality in Patients with Chronic Obstructive Pulmonary Disease

“…Factors independently related to an increase in mortality of COPD include age, race, gender, cigarette smoking, the number of comorbidities, body mass index (BMI), physical activity, air pollution, arterial carbon dioxide tension (PaCO 2 ), and hospitalization characteristics. [7][8][9][10][11][12][13] In addition, inflammation plays an important role in the pathogenesis and prognosis of COPD. 14 C-reactive protein (CRP), an acute-phase protein produced by the liver, is a marker of inflammation in the body.…”