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P3‐364: Chronic Obstructive Pulmonary Disease, Cognitive Function and Mortality in a U.S. National Cohort: Nhanes‐III
Author(s) -
Odeyemi Yewande,
Meda Edris,
Mehari Alem,
Obisesan Thomas O.,
Gillum Richard F.
Publication year - 2016
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2016.06.2030
Subject(s) - medicine , vital capacity , spirometry , copd , cohort , pulmonary function testing , airway obstruction , physical therapy , asthma , airway , lung function , surgery , diffusing capacity , lung
Background: Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease among elderly with its prognosis greatly determined by the presence of comorbidities including cognitive impairment. We hypothesized that baseline airway obstruction and cognitive impairment are independent predictors of survival in persons aged 60 years and over, and further that there is no positive interaction between these risk factors. Methods:We utilized the Third National Health and Nutrition Examination Survey (NHANES III), from 1988-1994 with mortality follow-up data through December 31, 2011. The ratio of the forced expiratory volume in the first second (FEV1) to the forced vital capacity (FVC) <0.7 was used to define airway obstruction. Cognitive function was assessed using a short index of cognitive function (SICF). SICF score <12 (range 0-17) indicated impairment in cognitive function. The number interviewed was 33,994 and 5,302 of these were aged 60 years. Of these 4,488 had mortality follow-up data, reliable spirometry data and no missing data. Results: 1930 (43%) were men and 2,558 (57%) were women. SICF <12 occurred in 2,761. 2152 had neither FEV1/FVC<0.7 nor SICF<12, 1131 had FEV1/FVC<0.7 only, 758 had SICF <12 only and 447 had both FEV1/FVC<0.7 and SICF<12. Over the follow-up period (min1⁄40, median1⁄4 200 months, maximum1⁄4 276 months) there were a total 3,335 deaths in the analysis sample. There were 1413 deaths among those with neither SICF <12 nor FEV1/FVC < 0.7, 902 with FEV1/FVC < 0.7 only, 615 with SICF <12 only and 405 with both SICF <12 and FEV1/FVC < 70%. Weighted Cox proportional hazards regression revealed increasing hazard ratio in persons with FEV1/FVC <0.7, SICF <12, and both FEV1/ FVC <0.7and SICF <12 respectively compared with persons with neither (reference group). After adjusting for multiple confounders, adjusted hazards ratios (95%CI) were 1.39(1.25-1.56)), 1.33 (1.15-1.53), 1.55(1.18-2.04), respectively. Further analysis assessing for interaction between FEV1/FVC ratio and SICF revealed a negative interaction (p 1⁄40.006) after adjusting for multiple confounders. Conclusions:Elderly persons with airway obstruction or cognitive impairment or both had increased all-cause mortality over the follow-up period when compared to those having neither. A negative interaction was significant. Further prospective studies are needed to replicate these findings.