THE ROLE OF SYSTEMIC INFLAMMATION IN THE ASSOCIATION OF OBESITY WITH MORTALITY AND HEALTH OUTCOMES AMONG COPD PATIENTS: A MEDIATION ANALYSIS
Author(s)
Kanishka Gahlot, MA1, Poorva Sardana, M.Sc.1, Manvi Sharma, MBA, MS, RPh, PhD1, Rajender Aparasu, PharmD, PhD2.
1Peritia, Morrisville, NC, USA, 2University of Houston, College of Pharmacy, Houston, TX, USA.
1Peritia, Morrisville, NC, USA, 2University of Houston, College of Pharmacy, Houston, TX, USA.
OBJECTIVES: Higher body mass index (BMI) has been reportedly associated with improved survival in Chronic Obstructive Pulmonary Disease (COPD), a phenomenon commonly known as ‘obesity paradox’. However, the role of systemic inflammation (SI) in this association is unclear. This study evaluated whether SI has a mediating effect on the relationship of BMI with all-cause mortality and health outcomes in COPD.
METHODS: This retrospective cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) data. Patients ≥18 years of age with COPD were included. All-cause mortality analyses were based on 2013-2018 NHANES, whereas other health outcomes (self-rated health, overnight hospitalization, and healthcare usage) utilized 2013-2020 NHANES. Multivariate logistic and ordinal logistic regression models were used to assess the association between BMI and health outcomes, after covariate adjustment. Mediation analyses assessed the role of SI in mediating these associations, measured via systemic inflammation index (SII).
RESULTS: A total of 1,332 (all-cause mortality cohort) and 1,551 participants (other outcomes cohort) were included, with a mean age of 59 years across the cohorts and a mean SII ranging from 617.65 to 629.05 (×103 cells/μL). Most patients were overweight to obese in both cohorts (77.4% to 76.8%). Overweight to obese individuals had lower odds of all-cause mortality (Odds Ratio (OR) = 0.55, p<0.01), and higher odds of excellent self-rated health (OR = 1.51, p<0.001) as compared to healthy-weight individuals. However, SI was not found to mediate this association (p>0.05). No significant associations between BMI and overnight hospitalization or healthcare usage were found.
CONCLUSIONS: Higher BMI was found to be associated with improved survival and self-rated health in COPD patients, indicating the presence of ‘obesity paradox’. However, these associations were not mediated by SI, highlighting the need for further research to understand the underlying mechanisms of this protective effect of higher BMI.
METHODS: This retrospective cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) data. Patients ≥18 years of age with COPD were included. All-cause mortality analyses were based on 2013-2018 NHANES, whereas other health outcomes (self-rated health, overnight hospitalization, and healthcare usage) utilized 2013-2020 NHANES. Multivariate logistic and ordinal logistic regression models were used to assess the association between BMI and health outcomes, after covariate adjustment. Mediation analyses assessed the role of SI in mediating these associations, measured via systemic inflammation index (SII).
RESULTS: A total of 1,332 (all-cause mortality cohort) and 1,551 participants (other outcomes cohort) were included, with a mean age of 59 years across the cohorts and a mean SII ranging from 617.65 to 629.05 (×103 cells/μL). Most patients were overweight to obese in both cohorts (77.4% to 76.8%). Overweight to obese individuals had lower odds of all-cause mortality (Odds Ratio (OR) = 0.55, p<0.01), and higher odds of excellent self-rated health (OR = 1.51, p<0.001) as compared to healthy-weight individuals. However, SI was not found to mediate this association (p>0.05). No significant associations between BMI and overnight hospitalization or healthcare usage were found.
CONCLUSIONS: Higher BMI was found to be associated with improved survival and self-rated health in COPD patients, indicating the presence of ‘obesity paradox’. However, these associations were not mediated by SI, highlighting the need for further research to understand the underlying mechanisms of this protective effect of higher BMI.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH121
Topic
Epidemiology & Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)