Abstract
Underlying chronic respiratory disease may be associated with the severity of coronavirus disease 2019 (COVID-19). This study investigated the impact of chronic obstructive pulmonary disease (COPD) on the risk for respiratory failure and mortality in COVID-19 patients. A nationwide retrospective cohort study was conducted in 4610 patients (≥ 40 years old) infected with COVID-19 between January 20 and May 27, 2020, using data from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The clinical course and various clinical features were compared between COPD and non-COPD patients, and the risks of respiratory failure and all-cause mortality in COPD patients were analyzed using a multivariate logistic regression model. Among 4610 COVID-19 patients, 4469 (96.9%) and 141 (3.1%) were categorized into the non-COPD and COPD groups, respectively. The COPD group had greater proportions of older (≥ 60 years old) (78.0% vs. 45.2%, P < 0.001) and male (52.5% vs. 36.6%, P < 0.001) patients than the non-COPD group. Relatively greater proportions of patients with COPD received intensive critical care (7.1% vs. 3.7%, P = 0.041) and mechanical ventilation (5.7% vs. 2.4%, P = 0.015). Multivariate analyses showed that COPD was not a risk factor for respiratory failure but was a significant independent risk factor for all-cause mortality (OR = 1.80, 95% CI 1.11–2.93) after adjustment for age, sex, and Charlson Comorbidity Index score. Among COVID-19 patients, relatively greater proportions of patients with COPD received mechanical ventilation and intensive critical care. COPD is an independent risk factor for all-cause mortality in COVID-19 patients in Korea.
Highlights
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a pandemic, with considerable morbidity and m ortality[1]
All hospitals and clinics in Korea submit medical records of patients covered by National Health Insurance (NHI) and Medical Aid to the Health Insurance Review and Assessment (HIRA) office for review to be reimbursed for any healthcare services p rovided[7]
This is the first nationwide population study to evaluate the impact of chronic obstructive pulmonary disease (COPD) on the clinical characteristics and prognosis of COVID-19 patients in South Korea
Summary
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a pandemic, with considerable morbidity and m ortality[1]. Extracted Data ᶃ Identification of COPD patients with ICD-10 codes (J43 and J44 except J43.0) ᶄ Comorbidities ᶃ Establishment of COPD severity according to COPD medication use and history exacerbations ᶄ History of acute exacerbation ᶅ Drug adherence assessment (medication possession rate). Previous studies have had important limitations, with relatively small sample sizes and data obtained from a single center or region. The impact of COPD on morbidity and mortality was not assessed in the context of other demographic factors, such as age, sex, or other comorbidities. We conducted a nationwide population-based study to analyze the impact of COPD on the risks of disease progression and mortality among COVID-19 patients in South Korea
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