The relationship between body mass index and health-related quality of life in COPD: real-world evidence based on claims
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RESEARCH
The relationship between body mass index and health‑related quality of life in COPD: real‑world evidence based on claims and survey data Manuel B. Huber1* , Christoph Kurz1, Florian Kirsch1,2, Larissa Schwarzkopf1,3,4, Anja Schramm5 and Reiner Leidl1,2,3
Abstract Background: Body mass index (BMI) is an important parameter associated with mortality and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD). However, informed guidance on stratified weight recommendations for COPD is still lacking. This study aims to determine the association between BMI and HRQoL across different severity grades of COPD to support patient management. Methods: We use conjunct analysis of claims and survey data based on a German COPD disease management program from 2016 to 2017. The EQ-5D-5L visual analog scale (VAS) and COPD Assessment Test (CAT) are used to measure generic and disease-specific HRQoL. Generalized additive models with smooth functions are implemented to evaluate the relationship between BMI and HRQoL, stratified by COPD severity. Results: 11,577 patients were included in this study. Mean age was 69.4 years and 59% of patients were male. In GOLD grades 1–3, patients with BMI of around 25 had the best generic and disease-specific HRQoL, whereas in GOLD grade 4, obese patients had the best HRQoL using both instruments when controlled for several variables including smoking status, income, COPD severity, comorbidities, emphysema, corticosteroid use, and days spent in hospital. Conclusion: This real-world analysis shows the non-linear relationship between BMI and HRQoL in COPD. HRQoL of obese patients with mild to severe COPD might improve following weight reduction. For very severe COPD, a negative association of obesity and HRQoL could not be confirmed. The results hint at the need to stratify COPD patients by disease stage for optimal BMI management. Keywords: COPD, BMI, Health-related quality of life, Obesity, Real-world evidence Background Despite being half as common as the most prevalent lung disease, asthma, chronic obstructive pulmonary disease (COPD) is associated with eight times higher mortality *Correspondence: manuel.huber@helmholtz‑muenchen.de 1 Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany Full list of author information is available at the end of the article
[1] and affects around 13.1% of humans worldwide [2]. COPD is associated with reduced health-related quality of life (HRQoL) [3]. Interestingly, the increasing problem of overweight [4] is associated with increased survival for COPD patients compared with their underweight and/or normal weight peers [5]. This association has been confirmed for a variety of other diseases including heart disease [6] and type 2 diabetes [7]. Some studies even extend this finding to the general population [8] and others refute it [9–11]. Although most related
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