Mortality in COPD and Cardiovascular Disease Comorbidity: Survival Analysis Using Curated Data From Brazilian Public Healthcare System (SUS)
Author(s)
JULIO CESAR B. OLIVEIRA, MD1, Marcelo Rabahi, PhD2.
1MD, Precision Data, São Paulo, Brazil, 2Goias Federal University, Goiania, Brazil.
1MD, Precision Data, São Paulo, Brazil, 2Goias Federal University, Goiania, Brazil.
OBJECTIVES: Cardiovascular disease (CVD) frequently coexists with chronic obstructive pulmonary disease (COPD), potentially worsening prognosis significantly. This study aimed to demonstrate the impact of the CVD on all-cause mortality among Brazilian COPD patients using ten-year real-world data from the public health system.
METHODS: A retrospective cohort analysis was conducted using the NEXUS administrative database (Precision Data DATASUS Database). The study included 54,950 adults aged over 40 (49.5% male, 50.5% female; mean age 66.3 years, (SD 10.88) who received at least one specialized COPD medication from the Brazilian Unified Health System (SUS) between January 2015 and December 2019. Patients were followed until December 31, 2024, and classified as CVD-positive (CVD+) if any cardiovascular diagnosis was recorded at baseline or during follow-up, or CVD-negative (CVD-) otherwise. Overall survival was estimated using Kaplan-Meier analysis, with curves compared using sex-stratified log-rank tests.
RESULTS: Of a total of 54,950 patients, 5,238 (9.5%) had CVD. CVD+ patients demonstrated significantly higher mortality across both sexes. In males, mortality was 25.8% (676/2,616) for CVD+ vs. 8.8% (2,157/24,546) for CVD- patients (HR=3.236, 95% CI: 2.968-3.528; p<0.001). In females, mortality was 20.1% (525/2,615) for CVD+ vs. 7.3% (1,825/25,133) for CVD- patients (HR=2.96, 95% CI: 2.69-3.26; p<0.001). Kaplan-Meier survival curves diverged early and remained separated throughout the 10-year follow-up, confirming persistently elevated mortality risk in CVD+ patients regardless of sex.
CONCLUSIONS: In this real-world Brazilian cohort, cardiovascular disease nearly tripled the ten-year mortality risk in COPD patients, regardless of sex. These findings emphasize the urgent need for an integrated task-force cardiovascular-respiratory care pathways to reduce mortality in this vulnerable population.
METHODS: A retrospective cohort analysis was conducted using the NEXUS administrative database (Precision Data DATASUS Database). The study included 54,950 adults aged over 40 (49.5% male, 50.5% female; mean age 66.3 years, (SD 10.88) who received at least one specialized COPD medication from the Brazilian Unified Health System (SUS) between January 2015 and December 2019. Patients were followed until December 31, 2024, and classified as CVD-positive (CVD+) if any cardiovascular diagnosis was recorded at baseline or during follow-up, or CVD-negative (CVD-) otherwise. Overall survival was estimated using Kaplan-Meier analysis, with curves compared using sex-stratified log-rank tests.
RESULTS: Of a total of 54,950 patients, 5,238 (9.5%) had CVD. CVD+ patients demonstrated significantly higher mortality across both sexes. In males, mortality was 25.8% (676/2,616) for CVD+ vs. 8.8% (2,157/24,546) for CVD- patients (HR=3.236, 95% CI: 2.968-3.528; p<0.001). In females, mortality was 20.1% (525/2,615) for CVD+ vs. 7.3% (1,825/25,133) for CVD- patients (HR=2.96, 95% CI: 2.69-3.26; p<0.001). Kaplan-Meier survival curves diverged early and remained separated throughout the 10-year follow-up, confirming persistently elevated mortality risk in CVD+ patients regardless of sex.
CONCLUSIONS: In this real-world Brazilian cohort, cardiovascular disease nearly tripled the ten-year mortality risk in COPD patients, regardless of sex. These findings emphasize the urgent need for an integrated task-force cardiovascular-respiratory care pathways to reduce mortality in this vulnerable population.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH166
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)