• Zhaolong Feng, Guoxian Li, Qida He, Na Sun, Tongxing Li, Qiang Han, Hanqing Zhao, Ze Ma, Mengtong Sun, Boyan Liu, Yu Wang, Zexin Lou, Siqian Ma, Yujie Shi, Jianing Li, Ziqing Sun, Miao Jiang, and Yueping Shen.
• Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, P. R. China; The Fourth Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
• Chest. 2024 Nov 15.

BackgroundThe independent, mediation, interaction, and joint effects of socioeconomic status (SES) and phenotypic frailty on the incidence of chronic obstructive pulmonary disease (COPD) are unclear.Research QuestionDo SES and frailty increase the risk of COPD independently or jointly ? Is there an interaction between the two factors in incident COPD? Does frailty play a mediating role between SES and COPD?Study Design And MethodsThis study included 396,106 UK Biobank participants without COPD at baseline. Latent class analysis was used to define the SES of participants. Frailty was defined by the frailty phenotypes according to five factors. Cox regression models were employed to examine the associations and calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Mediation and interaction analyses were used to explain the associations between SES and frailty on COPD risk.ResultsDuring a median follow-up period of 13.5 years, 12,626 individuals were diagnosed with COPD. Compared with individuals of high SES or robust, low SES (HR: 2.69, 95% CI: 2.48-2.92) or frailty (HR: 2.75, 95% CI: 2.58-2.93) increased the risk of COPD, respectively; 11.80% of the association between SES and COPD was mediated by frailty. In addition, there was a statistically significant additive interaction of low SES and frailty with COPD incidence (relative risk due to interaction: 3.591, 95% CI: 2.189-4.992; attributable proportion due to the interaction: 0.433, 95% CI: 0.276-0.589). Compared to robust individuals with high SES, frail individuals with low SES have the highest risk of COPD (HR: 7.85, 95% CI: 6.96-8.86).InterpretationLow SES and frailty are independent risk factors for COPD, and these two factors also have synergistic interaction in COPD. Frailty partially mediated the association between SES and COPD. Thus, the early identification and reversal of frailty may minimize the risk of COPD, especially in individuals with low SES.Copyright © 2024. Published by Elsevier Inc.

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