Background Identifying correlates of cause-specific mortality in patients with chronic obstructive pulmonary disease (COPD) may aid the targeting of therapies to reduce mortality. We determined factors associated with causes of death in a primary care COPD population. Methods Clinical Practice Research Datalink Aurum was linked to Hospital Episode Statistics and death certificate data. People with COPD alive between 1 January 2010 and 1 January 2020 were included. Patient characteristics were defined before the start of follow-up: (a) frequency and severity of exacerbations; (b) emphysema or chronic bronchitis; (c) Global Obstructive Lung Disease (GOLD) groups A–D; and (d) airflow limitation. We used Cox Proportional Hazards regression and competing risks to investigate the association between patient characteristics and risk of all-cause, COPD and cardiovascular (CV) mortality. Results 339 647 people with COPD were included of which 97 882 died during follow-up (25.7% COPD related and 23.3% CV related). Airflow limitation, GOLD group, exacerbation frequency and severity, and COPD phenotype were associated with all-cause mortality. Exacerbations, both increased frequency and severity, were associated with COPD-related mortality (≥2 exacerbations vs none adjusted HR: 1.64, 1.57–1.71; 1 severe vs none adjusted HR: 2.17, 2.04–2.31, respectively). Patients in GOLD groups B–D had a higher risk of COPD and CV mortality compared with GOLD group A (GOLD group D vs group A, adjusted HR for COPD mortality: 4.57, 4.23–4.93 and adjusted HR for CV mortality: 1.53, 1.41–1.65). Increasing airflow limitation was also associated with both COPD and CV mortality (GOLD 4 vs 1, adjusted HR: 12.63, 11.82–13.51 and adjusted HR: 1.75, 1.60–1.91, respectively). Conclusion Poorer airflow limitation, worse functional status and exacerbations had substantial associations with risk of all-cause mortality. Differing results for CV and COPD-related mortality suggests interventions to prevent mortality may need to target particular characteristics or time points in the disease course. Data may be obtained from a third party and are not publicly available. Data are available on request from the Clinical Practice Research Datalink (CPRD). Their provision requires the purchase of a license, and this license does not permit the authors to make them publicly available to all. This work used data from the version collected in May 2021 and have clearly specified the data selected within each Methods section. To allow identical data to be obtained by others, via the purchase of a license, the code lists will be provided upon request. Licenses are available from the CPRD (): The Clinical Practice Research Datalink Group, The Medicines and Healthcare products Regulatory Agency, 10 South Colonnade, Canary Wharf, London E14 4PU.

中文翻译：

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COPD 亚人群的特定原因死亡率：一项针对英格兰 339 647 人的队列研究

背景 识别慢性阻塞性肺疾病（COPD）患者特定原因死亡率的相关性可能有助于制定降低死亡率的治疗方案。我们确定了与初级保健慢性阻塞性肺病人群死亡原因相关的因素。方法 临床实践研究数据链 Aurum 与医院病例统计和死亡证明数据相关联。 2010 年 1 月 1 日至 2020 年 1 月 1 日期间存活的慢性阻塞性肺病患者也被纳入其中。在随访开始前定义患者特征：（a）恶化的频率和严重程度； (b) 肺气肿或慢性支气管炎； (c) 全球阻塞性肺病 (GOLD) A-D 组； (d) 气流限制。我们使用 Cox 比例风险回归和竞争风险来研究患者特征与全因死亡率、慢性阻塞性肺病 (COPD) 和心血管 (CV) 死亡率之间的关联。结果 共纳入 339 647 名 COPD 患者，其中 97 882 人在随访期间死亡（25.7% 与 COPD 相关，23.3% 与 CV 相关）。气流受限、GOLD 组、恶化频率和严重程度以及 COPD 表型与全因死亡率相关。急性加重（频率和严重程度均增加）与 COPD 相关死亡率相关（≥2 次急性加重 vs 未调整 HR：1.64、1.57–1.71；1 次严重加重 vs 未调整 HR：分别为 2.17、2.04–2.31）。与 GOLD A 组相比，GOLD B–D 组患者的 COPD 和心血管死亡风险较高（GOLD D 组与 A 组相比，针对 COPD 死亡率调整后的 HR：4.57、4.23-4.93，针对 CV 死亡率调整后的 HR：1.53、1.41 –1.65）。气流受限的增加也与 COPD 和 CV 死亡率相关（GOLD 4 vs 1，调整后 HR：12.63、11.82–13.51 和调整后 HR：1.75、1.60–1.91）。结论 较差的气流受限、较差的功能状态和病情恶化与全因死亡风险存在显着相关性。心血管病和慢性阻塞性肺病相关死亡率的不同结果表明，预防死亡的干预措施可能需要针对病程中的特定特征或时间点。数据可能从第三方获得，并且不公开。可根据临床实践研究数据链 (CPRD) 的要求提供数据。它们的提供需要购买许可证，并且该许可证不允许作者将它们公开提供给所有人。这项工作使用了 2021 年 5 月收集的版本中的数据，并明确指定了每个方法部分中选择的数据。为了允许其他人通过购买许可证获得相同的数据，将根据要求提供代码列表。许可证可从 CPRD 获得（)：临床实践研究数据链组，药品和保健品监管机构，10 South Colonnade, Canary Wharf, London E14 4PU。