@article {Kirui00711-2022, author = {Brian K. Kirui and Ailiana Santosa and Lowie E.G.W Vanfleteren and Huiqi Li and Stefan Franz{\'e}n and Caroline Stridsman and Fredrik Nyberg}, title = {Pre- and post-vaccination characteristics and risk factors for COVID-19 outcomes in a Swedish population-based cohort of COPD patients}, elocation-id = {00711-2022}, year = {2023}, doi = {10.1183/23120541.00711-2022}, publisher = {European Respiratory Society}, abstract = {Rationale Evidence on risk factors for Coronavirus disease 2019 (COVID-19) outcomes among patients with chronic obstructive pulmonary disease (COPD) in relation to COVID-19 vaccination remains limited.Objectives To characterize determinants of COVID-19 infection, hospitalization, intensive care unit (ICU) admission, and death in COPD patients in their unvaccinated state compared to when vaccinated.Methods We included all COPD patients in the Swedish National Airway Register (SNAR). Events of COVID-19 infection (test and/or healthcare encounter), hospitalization, ICU admission and death were identified 1Jan 2020{\textendash}30Nov 2021. Using adjusted Cox regression, associations between baseline sociodemographics, comorbidities, treatments, clinical measurements, and COVID-19 outcomes, during unvaccinated and vaccinated follow-up time, were analyzed.Results The population-based COPD cohort included 87 472 patients; among whom 6771 (7.7\%) COVID-19 infections, 2897 (3.3\%) hospitalizations, 233 (0.3\%) ICU admissions, and 882 (1.0\%) COVID-19 deaths occurred. During unvaccinated follow-up, risk of COVID-19 hospitalization and death increased with age, male sex, lower education, non-married status and being foreign-born. Comorbidities increased risk of several outcomes, e.g. respiratory failure for infection and hospitalization (adjusted HR 1.78, 95\%CI 1.58{\textendash}2.02 and 2.51, 2.16{\textendash}2.91, respectively), obesity for ICU admission (3.52, 2.29{\textendash}5.40) and cardiovascular disease for mortality (2.80, 2.16{\textendash}3.64). Inhaled COPD therapy was associated with infection, hospitalization, and death. COPD severity was also associated with COVID-19, especially hospitalization and death. Although the risk factor panorama was similar, COVID-19 vaccination attenuated HRs for some risk factors.Conclusion This study provides population-based evidence on predictive risk factors for COVID-19 outcomes, and highlights the positive implications of COVID-19 vaccination for COPD patients.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: CS has received personal fees from AstraZeneca, Boehringer-Ingelheim and Novartis for lectures at sponsored meetings.Conflict of interest: LV has received grants and personal fees from AstraZeneca and personal fees from GSK, Novartis, Boehringer-Ingelheim, Menarini, Resmed, Chiesi, AGA Linde, Zambon and Pulmonx.Conflict of interest: FN was an employee of AstraZeneca until 2019 and holds some AstraZeneca shares.Conflict of interest: SF is an employee of AstraZeneca as of October 2021 but the work in this paper relates to the period prior to this.Conflict of interest: BK, AS and HL have nothing to disclose.}, URL = {https://openres.ersjournals.com/content/early/2023/05/11/23120541.00711-2022}, eprint = {https://openres.ersjournals.com/content/early/2023/05/11/23120541.00711-2022.full.pdf}, journal = {ERJ Open Research} }