OBJECTIVES

Both aging and COPD are associated with increased comorbidities that may interfere with COPD treatment and contribute to poor outcomes. We quantified the prevalence and incidence of comorbidities in older patients with COPD using Medicare claims.

METHODS

A retrospective cohort study using a 5% Medicare beneficiary sample between 2012 and 2015. We included adults aged 65+ and diagnosed with COPD by 12/31/2014. Prevalence, co-prevalence, and incidence of 40 comorbidities were identified using the Medicare Chronic Conditions files.

RESULTS :

Of 461,268 eligible beneficiaries, 60% were female, 86% were white, with mean (standard deviation [SD]) age of 79 (8) years. Among these, 89.2% had at least five and 50.4% had at least ten comorbidities. Most prevalent comorbidities included hypertension (92.6%), hyperlipidemia (86.4%), anemia (74.9%), rheumatoid arthritis (RA) (68.0%), congestive heart failure (CHF) (49.6%), diabetes (46.7%), depression (43.7%), peripheral vascular disease (PVD) (42.9%), chronic kidney disease (CKD) (38.6%), asthma (38.3%), hypothyroid (36.3%), and pain (34.4%). Top co-prevalence of two conditions included hypertension-hyperlipidemia (82.4%), hypertension-anemia (71.7%), and hyperlipidemia-anemia (66.9%). Most common co-prevalence of three comorbidities were hypertension-hyperlipidemia-anemia (65.0%), hypertension-hyperlipidemia-RA (59.1%), and hypertension-anemia-RA (54.1%). Conditions with greater 1-year cumulative incidence pre-COPD diagnosis than 1-year incidence post-COPD included RA (71.4% vs 15.2%), anxiety (5.7% vs 4.2%), and tobacco use disorder (8.3% vs 7.3%). Some comorbidities had greater incidence in the 1-year post-period (hyperlipidemia: 28.2% vs 65.7%, anemia: 14.8% vs 18.9%, CHF: 8.7% vs14.4%, hyperlipidemia: 23.7% vs 35.9%, diabetes: 7.8% vs 11.0%, and cancer: 1.6% vs 3.4%).

CONCLUSIONS

Older COPD patients encounter high prevalence and co-prevalence of comorbidities. Understanding comorbidity patterns may provide insights into outcomes research and care management. The multimorbidity burden in this population highlights the importance of integrated care to improve health outcomes.