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Citation
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Adviento BA, Regan EA, Make BJ, Han MLK, Foreman MG, Iyer AS, Bhatt SP, Kim V, Bon J, Soler X, Kinney GL, Hanania NA, Lowe KE, Holm KE, Yohannes AM, Shinozaki G, Hoth KF, Fiedorowicz JG. Chest 2022; ePub(ePub): ePub. |
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Abstract
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Background
Studies have shown that chronic obstructive pulmonary disease (COPD) and smoking are associated with increased suicide risk. To date there are no prospective studies examining suicide risk among smokers along a spectrum of pulmonary disease ranging from completely normal spirometry to severe COPD.
Research Question
Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of heavy smokers within the COPDGene study?
Study Design and Methods
We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of current and former smokers. Primary cause of adjudicated deaths was identified using death certificates, family reports, and medical records. We examined time to death by suicide/overdose as the primary outcome in Cox regression adjusted for age, sex, race, BMI, pack-years, current smoking status, airflow limitation (%predicted FEV1), dyspnea (mMRC≥2), 6-minute walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time varying covariates and other causes of death as a competing risk.
Results
The cohort was 47% female, 33% Black (67% White), had a mean (SD) age of 59.6 (9.0) years, and mean FEV1 %predicted of 76.1 (25.5). 63 individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (HR=6.44, 95% CI 2.64-15.67), use of sedative/hypnotics (HR=2.33, 95% CI 1.24-4.38), and dyspnea (HR=2.23, 95% CI 1.34-3.70). Lower risk of was associated with older age (per decade HR=0.45, 95% CI 0.31-0.67), higher BMI (HR=0.95, 95% CI 0.91-0.99), and African American race (HR=0.41, 95% CI 0.23-0.74). Severity of airflow limitation (FEV %predicted) was not associated with suicide risk.
Interpretation
In this well-characterized cohort of current and former smokers with and without COPD, we identified risk factors for suicide/overdose that emphasize the subjective experience of illness over objective assessments of lung function.
Language: en |