Impact of COPD on mortality: An 8-year observational retrospective healthcare claims database cohort study.

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Here we present a large observational study on the association of COPD and exacerbations with mortality (AvoidEx Mortality).
Methods: A real-world, observational cohort study with longitudinal analyses of German healthcare claims data in patients ≥40 years of age with a COPD diagnosis from 2011 to 2018 (n = 250,723) was conducted. Patients entered the cohort (index date) upon the first COPD diagnosis. To assess the impact of COPD on all-cause death, a propensity score-matched control group of non-COPD patients was constructed. The number and severity of exacerbations during a 12-month pre-index period were used to form subgroups. For each exacerbation subgroup the exacerbations during 12 months prior to death were analysed.
Results: COPD increases the all-cause mortality risk by almost 60% (HR 1.57 (95% CI 1.55-1.59)) in comparison to matched non-COPD controls, when controlling for other baseline covariates. The cumulative risk of death after 8 years was highest in patients with a history of more than one moderate or severe exacerbation. Among all deceased COPD patients, 17.2% had experienced a severe, and 34.8% a moderate exacerbation, within 3 months preceding death. Despite increasing exacerbation rates towards death, more than the half of patients were not receiving any recommended pharmacological COPD therapy in the year before death.
Conclusion: Our study illustrates the impact of COPD on mortality risk and highlights the need for consequent COPD management comprising exacerbation assessment and treatment.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Joanna Diesing reports financial support was provided by WIG2 GmbH Scientific Institute for Health Economics and Health Service Research. Patrick Timpel reports financial support was provided by WIG2 GmbH Scientific Institute for Health Economics and Health Service Research. Nils Kossack reports financial support was provided by WIG2 GmbH Scientific Institute for Health Economics and Health Service Research. Marc Pignot reports financial support was provided by ZEG - Berlin Center for Epidemiology and Health Research GmbH. Felix W Friedrich reports financial support for data analysis and medical writing provided by AstraZeneca. Melanie Abram reports financial support was provided by AstraZeneca. Marija Halbach reports financial support was provided by AstraZeneca. Claus F Vogelmeier reports financial support was provided by AstraZeneca. Claus F Vogelmeier reports a relationship with Boehringer Ingelheim that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with CSL Behring that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Chiesi Pharmaceuticals GMBH that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with GlaxoSmithKline that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Grifols Deutschland GmbH Head Office that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with A Menarini Pharma GmbH that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Novartis that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Nuvaira Inc that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with MedUpdate that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Aerogen Ltd that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Sanofi-Aventis Deutschland GmbH that includes: consulting or advisory and funding grants. Claus F Vogelmeier reports a relationship with Roche that includes: consulting or advisory and funding grants.
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