National EHR Data Resource Reveals COVID-19’s Stark Mortality Risk in People with COPD

March 23, 2021

The large N3C cohort allowed researchers to find that people with COPD were more likely to be hospitalized and die of COVID-19, compared to those without COPD. (Magic mine/Shutterstock.com)

COVID-19 was twice as likely to be fatal for people with chronic obstructive pulmonary disease (COPD) than for those without COPD, according to researchers who mined a national enclave of COVID-19 clinical data maintained by NIH’s National Center for Advancing Translational Sciences (NCATS). The findings appeared in the International Journal of Chronic Obstructive Pulmonary Disease.

The data enclave is part of the National COVID Cohort Collaborative (N3C), which is speeding the search for clinically important answers as the pandemic evolves. The N3C Data Enclave is the largest collection of COVID-19 data from electronic health records (EHRs) representing people nationwide who were tested for or showed symptoms of COVID-19.

COPD is a chronic inflammatory lung disease most commonly caused by emphysema and chronic bronchitis. It’s the most common chronic lung disease in the United States and disproportionately impacts older adults.

Using the N3C Data Enclave, Northwestern University researchers assessed how COPD shaped mortality risk after a COVID-19 diagnosis. They reviewed EHR data from 387,008 people who tested positive for COVID-19, comparing the outcomes of the 7,449 people who tested positive and had COPD with the outcomes of those people who tested positive but did not have COPD.

“Whether COPD itself is a risk factor for worse outcomes from COVID-19 was an open question that required large observational databases to answer,” explained Ravi Kalhan, M.D., M.S., a study researcher, co-director of the Northwestern University Clinical and Translational Sciences Institute’s Center for Education and Career Development, and director of the Institute’s Master of Science in Clinical Investigation Program. “By collecting data from across the country through a variety of health systems, N3C allowed us to answer this question while ensuring the findings are generalizable to other health care settings.”

Among those with COVID-19, people with COPD were older (average age 71 years vs. 58 years) and more than twice as likely to be hospitalized than those without COPD (62% vs. 28%). People with COPD also were more likely to have hypertension, diabetes, obesity and chronic kidney disease.

The danger COVID-19 posed to people with COPD was stark: The mortality rate for those with COPD and COVID-19 was 15%, compared with 4% for those with COVID-19 but without COPD. After adjusting for risk factors, such as hypertension and obesity, people with COPD were found to be more than twice as likely to die from COVID-19 than those without COPD.

“The large N3C cohort allowed us to showcase that individuals with COPD were more likely to be hospitalized and die of COVID-19, compared with those without COPD,” explained study author Daniel Meza, a clinical fellow in the Division of Pulmonary and Critical Care Medicine at Northwestern University. “That means more must be done to protect these patients.”

The N3C is a partnership among the NCATS-supported Clinical and Translational Science Awards (CTSA) Program hubs, the National Center for Data to Health (CD2H), and the National Institute of General Medical Sciences-supported Institutional Development Award Networks for Clinical and Translational Research (IDeA-CTR), with overall stewardship by NCATS.

Learn more about the N3C’s data, capabilities and requirements for accessing the enclave.