Age-Specific Differences and Prognosis of Comorbidities in Chronic Obstructive Pulmonary Disease: A Nationwide Cohort Study

Background Chronic obstructive pulmonary disease (COPD) is frequently accompanied by multiple comorbidities that influence outcomes. However, age-specific differences in comorbidity patterns and their prognostic impact remain unclear. Methods Using a nationwide population-based cohort, we estimated the prevalence ratios (PRs) of major comorbidities comparing individuals with COPD to non-COPD controls across age groups by five clusters (cardiovascular, chronic respiratory, metabolic, multiple organ loss of tissue [MOLT], and mental). Among patients with COPD, we further examined age-related changes in comorbidity patterns. In addition, we assessed age-dependent associations between COPD and all-cause mortality compared with non-COPD individuals. For all analysis, multivariable-adjusted Cox proportional hazards models were used. Results A total of 349,933 individuals with COPD and 349,933 matched controls were analyzed. Compared with non-COPD individuals, those with COPD had a higher prevalence of most comorbidities across all age groups, particularly cardiovascular and chronic respiratory clusters. Comorbidity patterns within COPD varied with age, with relatively greater excess of respiratory comorbidities at younger ages and increasing burden of cardiovascular, metabolic, MOLT, and mental clusters with aging. Age-stratified analyses showed that the relative impact of comorbidities on all-cause mortality in COPD was greater at 40–59 years. Conclusion Comorbidities in COPD exhibit distinct age-dependent patterns with differential prognostic impact across the life course. These findings underscore that COPD is a complex, multisystem disease rather than an isolated pulmonary disorder, highlighting the need for a holistic, patient-centered approach to care.