COPD: Comorbidities in a High-Risk State

In Kentucky, chronic obstructive pulmonary disease (COPD) and multiple comorbidities are major public health issues. There is variation in the occurrence of both COPD and comorbidities depending on both gender and where in the state people live. Abulbaset Kamour, DrPH, MMedSci, MBChB, of the Department of Epidemiology at the University of Kentucky in Lexington, along with several colleagues examined data from the Behavior Risk Factor Surveillance System (BRFSS), and their work was recently published in Journal of the COPD Foundation.

The researchers set out to investigate “the burden of COPD in Kentucky and to evaluate the link between COPD and the major comorbidities with regard to age, sex, cigarette smoking, education level, income and Area Development Districts (ADDs).” There are 120 counties in Kentucky that share common characteristics. The ADDs are a network of “multi-county planning and development organizations.”

There were 9,585 participants from 15 ADDs, and of them 6,283 (65.5%) were women, with a mean age of 56.6 years. The men’s mean age was 53.7 years. The researchers found that the “rate of COPD varies considerably among the ADDs,” and is most prevalent in the Big Sandy and Kentucky River districts, where 18.8% and 16.8% of residents have the disease. The level of education was low in those two areas, as well. In all but one of the ADDs, COPD was more common among women than men.

The most common comorbidity was arthritis, then hypertension, depression, and diabetes. Women had arthritis and depression more often than men. When the data was adjusted for age, level of education, and smoking status, researchers found that “people with COPD had more risk of angina, arthritis, depression, diabetes and hypertension than people without COPD.”

The study has several limitations. For example, there was no laboratory testing to confirm the diagnosis of COPD, or the various comorbidities. Instead the researchers relied on the self-reported data from BRFSS. Despite those limitations and a few others, the researchers conclude that determining risk factors that may underlie gender differences and designing gender-based programs could reduce COPD comorbidities, improve prognoses, and improve the health-related quality of life for patients with COPD in Kentucky.