TY - JOUR
T1 - Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure
T2 - A Longitudinal Follow-up Study of the COPDGene Cohort
AU - COPDGene Investigators
AU - Adviento, Brigid A.
AU - Regan, Elizabeth A.
AU - Make, Barry J.
AU - Han, Mei Lan K.
AU - Foreman, Marilyn G.
AU - Iyer, Anand S.
AU - Bhatt, Surya P.
AU - Kim, Victor
AU - Bon, Jessica
AU - Soler, Xavier
AU - Kinney, Gregory L.
AU - Hanania, Nicola A.
AU - Lowe, Katherine E.
AU - Holm, Kristen E.
AU - Yohannes, Abebaw M.
AU - Shinozaki, Gen
AU - Hoth, Karin F.
AU - Fiedorowicz, Jess G.
AU - Crapo, James D.
AU - Silverman, Edwin K.
AU - Beaty, Terri H.
AU - Castaldi, Peter J.
AU - Cho, Michael H.
AU - DeMeo, Dawn L.
AU - El Boueiz, Adel
AU - Ghosh, Auyon
AU - Hayden, Lystra P.
AU - Hersh, Craig P.
AU - Hetmanski, Jacqueline
AU - Hobbs, Brian D.
AU - Hokanson, John E.
AU - Kim, Wonji
AU - Laird, Nan
AU - Lange, Christoph
AU - Lutz, Sharon M.
AU - McDonald, Merry Lynn
AU - Prokopenko, Dmitry
AU - Moll, Matthew
AU - Morrow, Jarrett
AU - Qiao, Dandi
AU - Saferali, Aabida
AU - Sakornsakolpat, Phuwanat
AU - Wan, Emily S.
AU - Yun, Jeong
AU - Centeno, Juan Pablo
AU - Wise, Robert
AU - Brown, Robert
AU - Hansel, Nadia N.
AU - Horton, Karen
AU - Putcha, Nirupama
N1 - Publisher Copyright:
© 2022 American College of Chest Physicians
PY - 2023/2
Y1 - 2023/2
N2 - Background: Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. Research Question: Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? Study Design and Methods: We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min 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 and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [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 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 individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.
AB - Background: Studies have shown that COPD and smoking are associated with increased suicide risk. To date, there are no prospective studies examining suicide risk among individuals with smoking exposure along a spectrum of pulmonary diseases ranging from normal spirometry to severe COPD. Research Question: Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of individuals with smoking exposure within the Genetic Epidemiology of COPD (COPDGene) study? Study Design and Methods: We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Primary cause of adjudicated deaths was identified by using death certificates, family reports, and medical records. Time to death by suicide/overdose was examined as the primary outcome in Cox regression models including age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), dyspnea (modified Medical Research Council scale score ≥ 2), 6-min 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 and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5. Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [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 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 individuals with smoking exposure with and without COPD, risk factors for suicide/overdose were identified that emphasize the subjective experience of illness over objective assessments of lung function.
KW - COPD
KW - overdose
KW - prospective cohort study
KW - suicide deaths
KW - tobacco smoking
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U2 - 10.1016/j.chest.2022.09.022
DO - 10.1016/j.chest.2022.09.022
M3 - Article
C2 - 36167120
AN - SCOPUS:85146895780
SN - 0012-3692
VL - 163
SP - 292
EP - 302
JO - CHEST
JF - CHEST
IS - 2
ER -