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Comorbidities contribute to the increased mortality observed among subjects with COPD, but the prognostic impact and possible sex differences have rarely been evaluated in population-based studies.

Aim: To evaluate the impact of common comorbidities; cardiovascular disease (CVD), diabetes mellitus (DM) and anxiety/depression (A/D), on mortality in a population-based study of subjects with (COPD) and without airway obstruction.

Methods: All subjects with airway obstruction (FEV1/(F)VC<0.70, n=993), were, together with age- and sex matched referents, identified after examinations of population-based cohorts in 2002-04. Spirometric groups: Normal Lung Function (NLF), COPD; post- bronchodilator fixed ratio (GOLD) and lower limit of normal (LLN). Mortality data were collected until December 2015.

Results: The cumulative mortality was significantly higher in GOLD-COPD than NLF, and higher in men than women in both groups. CVD, DM and A/D independently increased the risk for death (Hazard Ratio; 95% CI, 1.50-1.59; 1.07-2.11) in GOLD-COPD when adjusted for age, sex, smoking habits, BMI and FEV1% predicted, while in NLF A/D (1.54; 1.03-2.30) but not CVD (1.20; 0.87-1.65) or DM (1.46; 0.95-2.26). Among women with GOLD-COPD, CVD and A/D but not DM increased the risk for death, while among men DM and A/D, but not CVD. When the LLN-criterion was applied, the significantly increased risk for death associated with comorbidities remained among men, but not among women.

Conclusion: CVD, DM and A/D increased the risk for death in GOLD-COPD, but there seems to be sex-dependent differences in prognosis associated with comorbidities, also in relation to different spirometric criteria for COPD.