Comorbidity and Sex-Related Differences in Mortality in Oxygen-Dependent Chronic Obstructive Pulmonary Disease

Background: It is not known why survival differs between men and women in oxygen-dependent chronic obstructive pulmonary disease (COPD). The present study evaluates differences in comorbidity between men and women, and tests the hypothesis that comorbidity contributes to sex-related differences in mortality in oxygen-dependent COPD. Methods: National prospective study of patients aged 50 years or older, starting long-term oxygen therapy (LTOT) for COPD in Sweden between 1992 and 2008. Comorbidities were obtained from the Swedish Hospital Discharge Register. Sex-related differences in comorbidity were estimated using logistic regression, adjusting for age, smoking status and year of inclusion. The effect of comorbidity on overall mortality and the interaction between comorbidity and sex were evaluated using Cox regression, adjusting for age, sex, Pa O2 breathing air, FEV 1, smoking history and year of inclusion. Results: In total, 8,712 patients (55 % women) were included and 6,729 patients died during the study period. No patient was lost to follow-up. Compared with women, men had significantly more arrhythmia, cancer, ischemic heart disease and renal failure, and less hypertension, mental disorders, osteoporosis and rheumatoid arthritis (P,0.05 for all odds ratios). Comorbidity was an independent predictor of mortality, and the effect was similar for the sexes. Women had lower mortality, which remained unchanged even after adjusting for comorbidity; hazard ratio 0.73 (95 % confidence interval, 0.68–0.77; P,0.001)

Falls in the general elderly population: a 3- and 6- year prospective study of risk factors using data from the longitudinal population study 'Good ageing in Skane'.

Accidental falls in the elderly are a major health problem, despite extensive research on risk factors and prevention. Only a limited number of multifactorial, long-term prospective studies have been performed on risk factors for falls in the general elderly population. The aim of this study was to identify risk factors predicting falls in a general elderly population after three and six years, using a prospective design

Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis

Maternal obesity and excessive gestational weight gain may have persistent effects on offspring fat development. However, it remains unclear whether these effects differ by severity of obesity, and whether these effects are restricted to the extremes of maternal body mass index (BMI) and gestational weight gain. We aimed to assess the separate and combined associations of maternal BMI and gestational weight gain with the risk of overweight/obesity throughout childhood, and their population impact</p

Cox regression of overall mortality in patients starting long-term oxygen therapy, 1992–2008.

<p><i>Definition of abbreviations:</i> FEV₁ = forced expiratory volume in one second; Pa_O2 air = arterial blood gas tension of oxygen while breathing ambient air.</p>*<p>Never smoking is used as reference category.</p>†<p>Charlson score 0 is used as reference category.</p

Cox regression of the effects of individual comorbidities on overall mortality.

*<p>Never smoking is used as reference category.</p

Baseline characteristics of patients starting long-term oxygen therapy for chronic obstrucitve pulmonary disease, 1992–2008.

<p>Data presented as mean ± SD unless otherwise specified.</p><p><i>Definition of abbreviations:</i> FEV₁ = forced expiratory volume in one second; FVC = forced vital capacity; Pa_CO2 air = arterial blood gas tension of carbon dioxide while breathing ambient air; Pa_CO2 oxygen = arterial blood gas tension of carbon dioxide while breathing oxygen; Pa_O2 air = arterial blood gas tension of oxygen while breathing ambient air; Pa_O2 oxygen = arterial blood gas tension of oxygen while breathing oxygen.</p>*<p>Hospitalizations and in-hospital days within 5 years prior to starting LTOT, presented as median (first quartile – third quartile).</p

Prevalence and sex-related odds of comorbidity in patients starting long-term oxygen therapy for chronic obstructive pulmonary disease, 1992–2008.

<p>Percentages may not add up to 100 due to rounding.</p>*<p>Odds ratio adjusted for age, smoking history and year of starting long-term oxygen therapy.</p>†<p>Entities with significant sex-related difference in odds.</p

Prevalence and sex-related odds of Charlson score in patients starting long-term oxygen therapy for chronic obstructive pulmonary disease, 1992–2008.

<p>Percentages may not add up to 100 due to rounding.</p>*<p>Generalized ordered odds ratio adjusted for age, smoking history and year of inclusion. It is interpreted as the odds ratio of having a higher score than the present category.</p

Minimal Clinically Important Differences and Feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in Cardiorespiratory Disease

Context: Breathlessness is a cardinal symptom in cardiorespiratory disease and consists of multiple dimensions that can be measured using the instruments Dyspnea-12 (D12) and the Multidimensional Dyspnea Profile (MDP). Objectives: The objective of the study is to determine the minimal clinically important differences (MCIDs) of all D12 and MDP summary and subdomain scores as well as the instruments' feasibility in patients with cardiorespiratory disease. Methods: Prospective multicenter cohort study of outpatients with diagnosed cardiorespiratory disease and breathlessness in daily life. D12 and MDP were assessed at baseline, after 30-90 minutes and two weeks. MCIDs were calculated using anchor-based and distributional methods for summary and subdomain scores. Feasibility was assessed as rate of missing data, help required, self-reported difficulty, and completion time. Results: A total 182 outpatients (53.3% women) were included; main diagnoses were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%), and idiopathic pulmonary fibrosis (19%). Anchor-based MCIDs were for D12 total score 2.83 (95% CI 1.99-3.66); D12 physical 1.81 (1.29-2.34); D12 affective 1.07 (0.64-1.49); MDP A1 unpleasantness 0.82 (0.56-1.08); MDP perception 4.63 (3.21-6.05), and MDP emotional score 2.37 (1.10-3.64). The estimates were consistent with small-to-moderate effect sizes using distributional analysis, and MCIDs were similar between COPD and non-COPD patients. The instruments were generally feasible and quick to use. Conclusion: D12 and MDP are responsive to change and feasible for use for assessing multidimensional breathlessness in outpatients with cardiorespiratory disease. MCIDs were determined for use as endpoints in clinical trials