{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T02:44:11Z","timestamp":1783824251915,"version":"3.55.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD patients [entire cohort (EC), N\u2009=\u200912,779], 44% of the participants underwent additional health examination, and they were analysed separately [health-screening cohort (HSC), N\u2009=\u20095624]. Fifteen comorbidities previously reported as risk factors for mortality were studied using Cox proportional hazards regression models.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Total mortality rates were 38.6 per 1000 person-years (95% CI 37.32\u201340.01) and 27.4 per 1000 person-years (95% CI 25.68\u201329.22) in EC and HSC, respectively. The most common causes of death were disease progression, lung cancer, and pneumonia. Only some of the comorbidities had a direct impact on mortality. Multimorbidity, assessed by the number of comorbid diseases, was an independent risk factor of all-cause mortality in both cohorts and was a risk factor of respiratory mortality only in HSC. The Kaplan\u2013Meier analysis showed significant differences in survival trajectories according to the number of comorbidities in all-cause mortality but not in respiratory mortality. Low BMI, old age and male sex were independent risk factors for both mortalities in both cohorts.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The number of comorbidities might be an independent risk factor of COPD mortality. Multimorbidity contributes to all-cause mortality in COPD, but the effect of multimorbidity is less evident on respiratory mortality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12890-021-01424-7","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T17:04:01Z","timestamp":1613063041000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of multiple comorbidities on mortality in chronic obstructive pulmonary disease among Korean population: a nationwide cohort study"],"prefix":"10.1186","volume":"21","author":[{"given":"Youngmee","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye-Jee","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won-Kyung","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"key":"1424_CR1","unstructured":"GOLD. https:\/\/goldcopd.org\/. Global Initiative for Chronic Obstructive Lung Disease."},{"issue":"Suppl 1","key":"1424_CR2","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1097\/01.mcp.0000410744.75216.d0","volume":"17","author":"A Corsonello","year":"2011","unstructured":"Corsonello A, Antonelli Incalzi R, Pistelli R, Pedone C, Bustacchini S, Lattanzio F. Comorbidities of chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2011;17(Suppl 1):S21\u20138.","journal-title":"Curr Opin Pulm Med"},{"issue":"6","key":"1424_CR3","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1183\/09031936.00133805","volume":"28","author":"DD Sin","year":"2006","unstructured":"Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J. 2006;28(6):1245\u201357.","journal-title":"Eur Respir J"},{"issue":"6","key":"1424_CR4","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1111\/crj.13025","volume":"13","author":"JM Figueira-Goncalves","year":"2019","unstructured":"Figueira-Goncalves JM, Golpe R, Garcia-Bello MA, Garcia-Talavera I, Castro-Anon O. Comparison of the prognostic capability of two comorbidity indices in patients with chronic obstructive pulmonary disease, in real-life clinical practice. Clin Respir J. 2019;13(6):404\u20137.","journal-title":"Clin Respir J"},{"issue":"2","key":"1424_CR5","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1164\/rccm.201201-0034OC","volume":"186","author":"M Divo","year":"2012","unstructured":"Divo M, Cote C, de Torres JP, Casanova C, Marin JM, Pinto-Plata V, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;186(2):155\u201361.","journal-title":"Am J Respir Crit Care Med"},{"issue":"8","key":"1424_CR6","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1016\/j.jclinepi.2014.03.005","volume":"67","author":"A Frei","year":"2014","unstructured":"Frei A, Muggensturm P, Putcha N, Siebeling L, Zoller M, Boyd CM, et al. Five comorbidities reflected the health status in patients with chronic obstructive pulmonary disease: the newly developed COMCOLD index. J Clin Epidemiol. 2014;67(8):904\u201311.","journal-title":"J Clin Epidemiol"},{"issue":"12","key":"1424_CR7","doi-asserted-by":"publisher","first-page":"e114438","DOI":"10.1371\/journal.pone.0114438","volume":"9","author":"N Putcha","year":"2014","unstructured":"Putcha N, Puhan MA, Drummond MB, Han MK, Regan EA, Hanania NA, et al. A simplified score to quantify comorbidity in COPD. PLoS ONE. 2014;9(12):e114438.","journal-title":"PLoS ONE"},{"issue":"1","key":"1424_CR8","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12916-018-1159-7","volume":"16","author":"H Lee","year":"2018","unstructured":"Lee H, Shin SH, Gu S, Zhao D, Kang D, Joi YR, et al. Racial differences in comorbidity profile among patients with chronic obstructive pulmonary disease. BMC Med. 2018;16(1):178.","journal-title":"BMC Med"},{"key":"1424_CR9","unstructured":"NHISS. https:\/\/nhiss.nhis.or.kr\/bd\/ay\/bdaya001iv.do. National Health Insurance Sharing Service."},{"issue":"2","key":"1424_CR10","first-page":"e15","volume":"46","author":"J Lee","year":"2017","unstructured":"Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol. 2017;46(2):e15.","journal-title":"Int J Epidemiol"},{"key":"1424_CR11","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.2147\/COPD.S159249","volume":"13","author":"SC Park","year":"2018","unstructured":"Park SC, Kim YS, Kang YA, Park EC, Shin CS, Kim DW, et al. Hemoglobin and mortality in patients with COPD: a nationwide population-based cohort study. Int J Chron Obstruct Pulmon Dis. 2018;13:1599\u2013605.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"7","key":"1424_CR12","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1164\/rccm.201209-1665OC","volume":"187","author":"LE Vanfleteren","year":"2013","unstructured":"Vanfleteren LE, Spruit MA, Groenen M, Gaffron S, van Empel VP, Bruijnzeel PL, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(7):728\u201335.","journal-title":"Am J Respir Crit Care Med"},{"key":"1424_CR13","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.rmed.2016.05.019","volume":"117","author":"L Laforest","year":"2016","unstructured":"Laforest L, Roche N, Devouassoux G, Belhassen M, Chouaid C, Ginoux M, et al. Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: a population-based cohort study. Respir Med. 2016;117:33\u20139.","journal-title":"Respir Med"},{"issue":"4","key":"1424_CR14","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/j.rmed.2011.10.009","volume":"106","author":"LP McGarvey","year":"2012","unstructured":"McGarvey LP, Magder S, Burkhart D, Kesten S, Liu D, Manuel RC, et al. Cause-specific mortality adjudication in the UPLIFT(R) COPD trial: findings and recommendations. Respir Med. 2012;106(4):515\u201321.","journal-title":"Respir Med"},{"issue":"6","key":"1424_CR15","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1539\/joh.45.335","volume":"45","author":"E Anuurad","year":"2003","unstructured":"Anuurad E, Shiwaku K, Nogi A, Kitajima K, Enkhmaa B, Shimono K, et al. The new BMI criteria for asians by the regional office for the western pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health. 2003;45(6):335\u201343.","journal-title":"J Occup Health"},{"issue":"1","key":"1424_CR16","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12931-017-0512-2","volume":"18","author":"JA Westerik","year":"2017","unstructured":"Westerik JA, Metting EI, van Boven JF, Tiersma W, Kocks JW, Schermer TR. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respir Res. 2017;18(1):31.","journal-title":"Respir Res"},{"issue":"1","key":"1424_CR17","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12890-018-0573-0","volume":"18","author":"G Johansson","year":"2018","unstructured":"Johansson G, Mushnikov V, Backstrom T, Engstrom A, Khalid JM, Wall J, et al. Exacerbations and healthcare resource utilization among COPD patients in a Swedish registry-based nation-wide study. BMC Pulm Med. 2018;18(1):17.","journal-title":"BMC Pulm Med"},{"issue":"4","key":"1424_CR18","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1378\/chest.128.4.2099","volume":"128","author":"JB Soriano","year":"2005","unstructured":"Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. Chest. 2005;128(4):2099\u2013107.","journal-title":"Chest"},{"issue":"5","key":"1424_CR19","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1183\/09031936.00128008","volume":"33","author":"PJ Barnes","year":"2009","unstructured":"Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33(5):1165\u201385.","journal-title":"Eur Respir J"},{"key":"1424_CR20","doi-asserted-by":"publisher","first-page":"173","DOI":"10.2147\/COPD.S74645","volume":"10","author":"J Sundh","year":"2015","unstructured":"Sundh J, Johansson G, Larsson K, Linden A, Lofdahl CG, Janson C, et al. Comorbidity and health-related quality of life in patients with severe chronic obstructive pulmonary disease attending Swedish secondary care units. Int J Chron Obstruct Pulmon Dis. 2015;10:173\u201383.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"12","key":"1424_CR21","doi-asserted-by":"publisher","first-page":"2794","DOI":"10.1183\/09031936.97.10122794","volume":"10","author":"R Antonelli Incalzi","year":"1997","unstructured":"Antonelli Incalzi R, Fuso L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10(12):2794\u2013800.","journal-title":"Eur Respir J"},{"issue":"28","key":"1424_CR22","doi-asserted-by":"publisher","first-page":"e4225","DOI":"10.1097\/MD.0000000000004225","volume":"95","author":"Y Guo","year":"2016","unstructured":"Guo Y, Zhang T, Wang Z, Yu F, Xu Q, Guo W, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a dose-response meta-analysis. Medicine (Baltimore). 2016;95(28):e4225.","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"1424_CR23","doi-asserted-by":"publisher","first-page":"e009121","DOI":"10.1136\/bmjopen-2015-009121","volume":"6","author":"LC Hunter","year":"2016","unstructured":"Hunter LC, Lee RJ, Butcher I, Weir CJ, Fischbacher CM, McAllister D, et al. Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records. BMJ Open. 2016;6(1):e009121.","journal-title":"BMJ Open"},{"issue":"3","key":"1424_CR24","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1183\/09031936.00096108","volume":"33","author":"JP de Torres","year":"2009","unstructured":"de Torres JP, Cote CG, Lopez MV, Casanova C, Diaz O, Marin JM, et al. Sex differences in mortality in patients with COPD. Eur Respir J. 2009;33(3):528\u201335.","journal-title":"Eur Respir J"},{"issue":"1","key":"1424_CR25","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1183\/09031936.00194610","volume":"39","author":"CR Jenkins","year":"2012","unstructured":"Jenkins CR, Celli B, Anderson JA, Ferguson GT, Jones PW, Vestbo J, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J. 2012;39(1):38\u201345.","journal-title":"Eur Respir J"},{"issue":"10","key":"1424_CR26","first-page":"A5137","volume":"62","author":"K Salte","year":"2015","unstructured":"Salte K, Titlestad I, Halling A. Depression is associated with poor prognosis in patients with chronic obstructive pulmonary disease - a systematic review. Dan Med J. 2015;62(10):A5137.","journal-title":"Dan Med J"},{"issue":"11","key":"1424_CR27","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1136\/thx.2009.128082","volume":"65","author":"JR Feary","year":"2010","unstructured":"Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010;65(11):956\u201362.","journal-title":"Thorax"},{"issue":"2","key":"1424_CR28","doi-asserted-by":"publisher","first-page":"62","DOI":"10.4235\/agmr.20.0002","volume":"24","author":"DH Kim","year":"2020","unstructured":"Kim DH. Measuring frailty in health care databases for clinical care and research. Ann Geriatr Med Res. 2020;24(2):62\u201374.","journal-title":"Ann Geriatr Med Res"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-021-01424-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12890-021-01424-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-021-01424-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T12:03:56Z","timestamp":1617883436000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-021-01424-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,11]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1424"],"URL":"https:\/\/doi.org\/10.1186\/s12890-021-01424-7","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,11]]},"assertion":[{"value":"18 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 February 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was reviewed and approved by the Institutional Review Board of the Asan Medical Center (Approval number: 2018-0971). Informed consent was waived by the IRB because it used existing database that were provided in a de-identified format. All methods were carried out in accordance with relevant guidelines and regulations.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that thy have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"56"}}