Chronic Obstructive Pulmonary Disease (COPD) as a disease of early aging: Evidence from the EpiChron Cohort

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From: PLoS ONE(Vol. 13, Issue 2)
Publisher: Public Library of Science
Document Type: Report
Length: 6,104 words
Lexile Measure: 1540L

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Author(s): Miguel J. Divo 1,*, Bartolome R. Celli 1, Beatriz Poblador-Plou 2, Amaia Calderón-Larrañaga 2, Juan Pablo de-Torres 3, Luis A. Gimeno-Feliu 2, Juan Bertó 3, Javier J. Zulueta 3, Ciro Casanova 4, Victor M. Pinto-Plata 5, Carlos Cabrera-Lopez 6, Francesca Polverino 1, Jonás Carmona Píréz 2, Alexandra Prados-Torres 2, Jose M. Marin 7, on behalf of the EpiChron-BODE Collaborative Group


An increase in life expectancy has led to the aging of populations worldwide[1]. Aging is an important known risk factors for most chronic diseases, however there is variability in the burden of chronic diseases affecting the old[2,3]. Understanding this variability is key to differentiating pathologic from successful or normal aging[4]. The co-occurrence of chronic diseases is not a phenomenon of simple chance[5-7], but rather the expression of complex biological interactions between a susceptible individual and the cumulative effect of environmental exposures, differentially affecting body systems[8].

Chronic Obstructive Pulmonary Disease (COPD) is a representative model of a disease to help discern pathologic from normal aging[9]: COPD is a disease which affects millions of people[10], is the third leading cause of death worldwide [11], has a natural history that is relatively well understood[12] and frequently occurs with comorbidities[13,14]. Moreover, in a big data longitudinal study of the entire Danish population (6.2 million subjects), COPD was identified as a disease central to the progression of other chronic diseases[15].

COPD is thought to occur due to the slow, progressive and cumulative inflammatory response to inhaled particles, primarily from cigarette smoke and biomass fuel pollution. Such low grade persistent inflammation is a phenomenon associated with aging (thus the term "inflammaging"[16]), leading to the suggestion that COPD may actually represent a disease of accelerated aging[17,18].

Using network analysis, we tested the hypothesis that patients with a diagnosis of COPD would not only have an increased number of comorbidities characteristically seen in older individuals, but these would be detected at a younger age.


Study design and population

COPD cases and controls were selected from the EpiChron Cohort[19], which links, at the individual level, clinical and demographic information contained in the electronic medical records (EMR) of the 1.3 million inhabitants of the Spanish autonomous community of Aragon. The Spanish Health System is a single-payer, universal coverage, primary care based model, managed by the distinct autonomous communities[20]. The single, interconnected EMR system was implemented in the Aragon province in 2006 and since then each electronic medical record has accumulated past and new diagnoses generated from patient's encounters including outpatient, hospital or emergency visit and from a proxy methods consisting of linking a specific diagnosis to every prescription and diagnostic. In this cross-sectional analysis, we included the anonymized records in the year 2011 of all individuals aged 40 years and older (n = 727,241), with a physician diagnosis of COPD and an equal number of age and gender matched group of subjects without the diagnosis. COPD cases were identified as those individuals carrying in their EMR any of the following International Classification of Diseases 9th Edition (ICD9)...

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Gale Document Number: GALE|A528555528