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Lutter, J. ; Jörres, R.A.* ; Welte, T.* ; Watz, H.* ; Waschki, B.* ; Alter, P.* ; Trudzinski, F.C.* ; Ohlander, J. ; Behr, J.* ; Bals, R.* ; Studnicka, M.* ; Holle, R.* ; Vogelmeier, C.F.* ; Kahnert, K.*

Impact of education on COPD severity and all-cause mortality in lifetime never-smokers and longtime ex-smokers: Results of the COSYCONET cohort.

Int. J. Chron. Obstruct. Pulmon. Dis. 15, 2787-2798 (2020)

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Background: Beyond smoking, several risk factors for the development of chronic obstructive pulmonary disease (COPD) have been described, among which socioeconomic status including education is of particular interest. We studied the contribution of education to lung function and symptoms relative to smoking in a group of never-smokers with COPD compared to a group of long-time ex-smokers with COPD. Methods: We used baseline data of the COSYCONET cohort, including patients of GOLD grades 1-4 who were either never-smokers (n=150, age 68.5y, 53.3% female) or ex-smokers (≥10 packyears) for at least 10 years (n=616, 68.3y, 29.9% female). Socioeconomic status was analyzed using education level and mortality was assessed over a follow-up period of 4.5 years. Analyses were performed using ANOVA and regression models. Results: Spirometric lung function did not differ between groups, whereas CO diffusing capacity and indicators of lung hyperinflation/air-trapping showed better values in the never-smoker group. In both groups, spirometric lung function depended on the education level, with better values for higher education. Quality of life and 6-MWD were significantly different in never-smokers as well as patients with higher education. Asthma, alpha-1-antitrypsin deficiency, and bronchiectasis were more often reported in never-smokers, and asthma was more often reported in patients with higher education. Higher education was also associated with reduced mortality (hazard ratio 0.46; 95% CI 0.22-0.98). Conclusion: Overall, in the COSYCONET COPD cohort, differences in functional status between never-smokers and long-time ex-smokers were not large. Compared to that, the dependence on education level was more prominent, with higher education associated with better outcomes, including mortality. These data indicate that non-smoking COPD patients' socioeconomic factors are relevant and should be taken into account by clinicians.

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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Copd ; Education ; Never-smoker ; Socioeconomic Status; Socioeconomic-status; Cigarette-smoking; Physical-activity; Level; Comorbidities; Prevalence; Health; Asthma

ISSN (print) / ISBN 1176-9106

e-ISSN 1178-2005

Journal International Journal of Chronic Obstructive Pulmonary Disease

Quellenangaben Volume: 15, Pages: 2787-2798

Publisher Dove Medical Press

Publishing Place Albany, Auckland

Non-patent literature Publications

Reviewing status Peer reviewed

Institute(s) Institute of Health Economics and Health Care Management (IGM)
Lung Health and Immunity (LHI)

Grants Novartis Deutschland GmbH
Grifols Deutschland GmbH
GlaxoSmithKline GmbHCo. KG
Pharma GmbH Co. KG
Boehringer Ingelheim
AstraZeneca GmbH
BMBF
German Centre for Lung Research (DZL)