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Multimorbidity clusters in patients with chronic obstructive airway diseases in the EpiChron Cohort

Abstract

Objectives

Chronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common treatable and preventable chronic conditions with high morbidity burden and mortality risk. We aimed to explore the existence of multimorbidity clusters in patients with such diseases and to estimate their prevalence and impact on mortality.

Methods

We conducted an observational retrospective study in the EpiChron Cohort. This cohort integrates, at the patient level, demographic and clinical information of the population assigned to the public health system in the Spanish region of Aragon (1.3 M individuals; approximately 98% of the total population of Aragon). The cohort profile, with a detailed description of data sources used, is published elsewhere³⁷.

Results

The study population was composed of 127,530 individuals 15 years of age and older with a diagnosis of at least one of the chronic obstructive airway diseases studied, representing 10.2% of the reference population in the EpiChron Cohort. The most frequent chronic obstructive airway disease in both sexes was allergic rhinitis, followed by asthma, COPD, and OSA (Table 1). Allergic rhinitis and asthma were more frequent in women than in men, while COPD and OSA were more common in men. Three in every four patients had at least one co-existing chronic condition, with an average of 3.7 diseases per patient. Women showed a higher morbidity burden compared with men.

Conclusions

Multimorbidity affects almost three in every four patients with chronic obstructive airway diseases. The number and complexity of the identified multimorbidity clusters increase with age in both genders, revealing some unexpected systematic associations between diseases and a differential impact on mortality. The complex clinical profile of patients with the most prevalent chronic obstructive airway diseases highlights the need to implement holistic and person-centered clinical management approaches. Our findings may provide useful information when planning healthcare interventions targeting patients with chronic obstructive airway diseases and multiple chronic conditions. Further large-scale studies in different clinical settings and populations are encouraged to validate the results.