Trends in Cause-Specific Mortality in Oxygen-dependent Chronic Obstructive Pulmonary Disease
Trends in Cause-Specific Mortality in Oxygen-dependent Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.201010-1704oc
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发表时间：
2011-04-15
影响因子：
24.7
通讯作者：
Strom, Kerstin E.
中科院分区：
文献类型：
--
作者：
Ekstrom, Magnus P.;Wagner, Philippe;Strom, Kerstin E.
基本原理：自从在慢性阻塞性肺疾病（COPD）伴慢性缺氧患者中引入长期氧疗（LTOT）以来，开始LTOT的女性比例和患者年龄显著增加。我们假设，这可能会导致死亡原因随着时间的推移而发生变化。Objective. To测试的原因特异性死亡率在COPD与LTOT.Methods的时间趋势：患者开始LTOT的COPD在瑞典1987年1月1日至2004年12月31日之间被纳入一项国家前瞻性研究和监测，直到退出LTOT，死亡，或2004年12月31日。主要终点是从瑞典死因死亡Register.Measurements和主要结果获得的死亡原因：共7,628例患者（53%的妇女）进行了监测，中位数为1.7年（范围，0-18.0年）。没有患者失访，5，457名患者在研究期间死亡。粗死亡率每年增加1.6%（95%置信区间[CI]，0.9-2.2%/年; P < 0.001）。循环系统疾病的死亡绝对风险每年增加2.8%（95%CI，1.3-4.3%/年; P < 0.001），消化器官疾病的死亡绝对风险每年增加7.8%（95%CI，1.9-14.0%/年; P = 0.009）。呼吸系统疾病死亡的绝对危险度每年下降2.7%（95%CI，2.0-3.3%/yr; P < 0.001），肺癌死亡的绝对危险度每年下降3.4%（95%CI，1.1-5.7%/yr; P = 0.004）。这突出了优化诊断和治疗合并症以降低发病率和死亡率的重要性。
Rationale: Since the introduction of long-term oxygen treatment (LTOT) in chronic obstructive pulmonary disease (COPD) with chronic hypoxia, the proportion of women and the age of patients starting LTOT have increased markedly. We hypothesize that this might have led to shifts in the causes of death over time.Objectives: To test for time trends in cause-specific mortality in COPD with LTOT.Methods: Patients starting LTOT for COPD in Sweden between January 1, 1987 and December 31, 2004 were included in a national prospective study and monitored until withdrawal of LTOT, death, or December 31, 2004. The primary end point was cause of death obtained from the Swedish Causes of Death Register.Measurements and Main Results: A total of 7,628 patients (53% women) were monitored for a median of 1.7 years (range, 0-18.0 yr). No patient was lost to follow-up and 5,457 patients died during the study. The crude overall mortality increased by 1.6%/year (95% confidence interval [CI], 0.9-2.2%/yr; P < 0.001). The absolute risk of death increased for circulatory disease by 2.8%/year (95% CI, 1.3-4.3%/yr; P < 0.001) and for digestive organ disease by 7.8%/year (95% CI, 1.9-14.0%/ yr; P = 0.009). The absolute risk of death decreased for respiratory disease by 2.7%/year (95% CI, 2.0-3.3%/yr; P < 0.001) and for lung cancer by 3.4%/year (95% CI, 1.1-5.7%/yr; P = 0.004).Conclusions: In oxygen-dependent COPD, mortality has increased over time both overall and of nonrespiratory causes, including cardiovascular disease. This highlights the importance of optimized diagnostics and treatment of comorbidities to decrease morbidity and mortality.