The HUNT study: Association of comorbidity clusters with long‐term survival and incidence of exacerbation in a population‐based Norwegian COPD cohort. Issue 4 (10th February 2022)

• Record Type: Journal Article
• Authors: Vikjord, Sigrid Anna Aalberg; Brumpton, Ben Michael; Mai, Xiao‐Mei; Romundstad, Solfrid; Langhammer, Arnulf; Vanfleteren, Lowie
• Is Part Of: Respirology. Volume 27:Issue 4(2022)
• Page Start: 277
• Page End: 285
• Publication Date: 2022-02-10
• Subjects: chronic obstructive pulmonary disease -- clinical epidemiology -- comorbidity cluster -- COPD exacerbation -- HUNT study; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.14222
• Languages: English
• ISSNs: 1323-7799

Abstract

Abstract: Background and objective: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease often viewed as part of a multimorbidity complex. There is a need for better phenotyping of the disease, characterization of its interplay with other comorbidities and its association with long‐term outcomes. This study aims to examine how clusters of comorbidities are associated with severe exacerbations and mortality in COPD. Methods: Participants with potential COPD were recruited from the second (1995–1997) and third (2006–2008) survey of the HUNT Study and followed up until April 2020. Ten objectively identified comorbidities were clustered using self‐organizing maps. Severe COPD exacerbations requiring hospitalization were assessed using hospital data. All‐cause mortality was collected from national registries. Multivariable Cox regression was used to calculate hazard ratios (HRs) with 95% CIs for the association between comorbidity clusters and all‐cause mortality. Poisson regression was used to calculate incidence rate ratios (IRRs) with 95% CI for the cumulative number of severe exacerbations for each cluster. Results: Five distinct clusters were identified, including 'less comorbidity', 'psychological', 'cardiovascular', 'metabolic' and 'cachectic' clusters. Using the less comorbidity cluster as reference, the psychological and cachectic clusters were associated with all‐cause mortality (HR 1.23 [1.04–1.45] and HR 1.83 [1.52–2.20], adjusted for age and sex). The same clusters also had increased risk of exacerbations (unadjusted IRR of 1.24 [95% CI 1.04–1.48] and 1.50 [95% CI 1.23–1.83], respectively). Conclusion: During 25 years of follow‐up, individuals in the psychological and cachectic clusters had increased mortality. Furthermore, these clusters were associated with increased risk of severe COPD exacerbations. Abstract : In a chronic obstructive pulmonary disease (COPD) cohort recruited from a general population, we confirmed five distinct comorbidity clusters. Two of these, a psychological and a cachectic cluster, were significantly associated with mortality and the risk of severe COPD exacerbations. See related Editorial