Work

Associated factors and outcomes of social activity restriction in patients with chronic obstructive pulmonary disease: a real-world longitudinal cohort study

Year: 2026

Type: article

Abstract: Background: Social activity restriction has emerged as a new public health challenge; the factors associated with social activity restriction and its outcomes in patients with chronic obstructive pulmonary disease (COPD) are not yet clear. In this study, we aimed to describe the clinical characteristics of socially restricted COPD patients and to evaluate the effects of social activity restriction on acute exacerbation and mortality. Methods: We included participants enrolled in the RealDTC study between December 2016 and August 2020. We collected data on demographics, degree of social activity restriction, lung function, Clinical COPD Questionnaire score, and mortality at four years. We used multivariable regression analyses to examine whether restricted social activity was associated with the risks of acute exacerbation and mortality. Results: We included 3,679 patients in total. Their mean age was 65.72 (standard deviation = 9.1) years, and 11.3% had restricted social activities. Older age, widowhood, GOLD grades 3-4, Global Initiative for Chronic Obstructive Lung Disease groups B and D, history of acute exacerbation, COPD Assessment Test score of ≥10, and Modified Medical Research Council score of ≥2 were independently associated with social activity restriction. By multivariable analysis, patients with restricted social activities had higher risks of future acute exacerbation (adjusted odds ratio (aOR) = 1.320; 95% confidence interval (CI) = 1.100-1.583, P = 0.003) and severe acute exacerbation (aOR = 1.299; 95% CI = 1.014-1.664, P = 0.038). Furthermore, restricted social activity was an independent risk factor for mortality (hazard ratio = 1.752, 95% CI = 1.298-2.364, P < 0.001). Conclusions: Restricted social activity was not uncommon among patients with COPD. Social activity restriction should be routinely assessed in COPD clinics as a simple marker to identify patients at increased risk of exacerbation and mortality. During future epidemics or pandemics, public health responses should be more flexible, risk-stratified, and patient-centred for individuals with chronic respiratory disease. Future interventional and policy studies are needed to determine whether systematic assessment of social activity restriction and targeted supportive programs can improve outcomes in socially restricted patients with COPD.

Source: Journal of Global Health

DOI: 10.7189/jogh.16.04295