Association between chronic comorbidity and exacerbation rate in primary care COPD patients. Preliminary analysis of real-life general practice data (PROSPECT1)

Abstract

Aim: To study associations between a wide range of chronic comorbidities and the occurrence of exacerbations in primary care COPD patients. Method: Retrospective cohort study based on 2012-2013 electronic health records of 178 general practices in the Netherlands. Patients with physician-diagnosed COPD were analyzed for their comorbidities, which were categorized according to International Classification of Primary Care (ICPC) codes. Χ 2 tests and logistic regression were used to univariately explore associations between comorbidities and exacerbation occurrence, defined by oral corticosteroids prescriptions. Results: 16,427 patients with COPD were included. Mean age at study start was 67 years [SD 12], 47.1% were women. At baseline 89.1% of patients suffered from ≥1 comorbidities, while 23.1% had ≥5 comorbidities. Most prevalent comorbid conditions were hypertension (35.2%); coronary heart disease (19.2 %); osteoarthritis (17.6%); diabetes (17.3%). 32% of patients had ≥1 exacerbation and 5.7% ≥4 exacerbations during the 2 years study period. Patients with ≥1 comorbid conditions more often had ≥2 exacerbations per year compared to patients without comorbidity (5.9% vs 4.0%, p=0.001). Patients with another chronic respiratory disease next to their COPD, (n=2,188) were at risk for ≥2 exacerbations per year (OR 1.39; [95%CI 1.16-1.66]). Conclusion: Chronic comorbidity is highly prevalent in COPD patients in general practice. COPD patients with comorbidities seem to experience more exacerbations. Further (multivariate) analyses will be performed to elucidate the possible impact of comorbidity on COPD exacerbation risk.