Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort

COPDGene Investigators

doi:10.1016/j.chest.2022.09.022

Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort

COPDGene Investigators

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	292-302
Number of pages	11
Journal	CHEST
Volume	163
Issue number	2
DOIs	https://doi.org/10.1016/j.chest.2022.09.022
State	Published - Feb 2023

Bibliographical note

Funding Information:
The project described was supported by Award Number U01 HL089897 and Award Number U01 HL089856 from the National Heart, Lung, and Blood Institute . The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sunovion.

Funding Information:
The authors have reported to CHEST the following: B. J. M. reports grants or contracts paid to the institution from the NIH, American Lung Association, Department of Defense, and Astra Zeneca. He reports royalties from Wolters Kluwer Health (Up-To-Date) and consulting fees from Astra Zeneca and Third Pole. He has received honoraria or speaking fees from Astra Zeneca, Mt. Sanai, Web MD, Novartis, the American College of Chest Physicians, Projects in Knowledge, Eastern Pulmonary Society, Optimum Patient Care Global Limited, GlaxoSmithKline, Boston University Medical Center and Integritas Communications. He has served on monitoring or advisory boards for Spiration, GlaxoSmithKline, Mt. Sinai, Boehringer Ingelheim, Mylan, Quintiles, University of Wisconsin, Baystate Medical Center and AstraZeneca. M. K. H. reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, Regeneron, United Therapeutics, UpToDate, Altesa Biopharma, Medscape and Integrity. She has received either in kind research support or funds paid to the institution from the NIH, Novartis, Sunovion, Nuvaira, Sanofi, Astrazeneca, Boehringer Ingelheim, Gala Therapeutics, and Biodesix. She has participated in Data Safety Monitoring Boards for Novartis and Medtronic with funds paid to the institution. She has received stock options from Meissa Vaccines and Altesa Biopharma. A. S. I. reports consulting fees from AstraZeneca and speaking fees from Ascension St. Vincent's. S. P. B. has received consulting fees from Boehringer Ingelheim and Sanofi and CME fees from IntegrityCE. V. K. has received consultancy fees from Gala Therapeutics and AstraZeneca. X. S. is a full-time employee of Regeneron Pharmaceuticals, Inc. and owns restricted shares and or stock options. A. M. Y. has received a consultation fee from Astrazeneca. None declared (B. A. A., E. A. R., M. G. F., J. B., G. L. K., N. A. H., K. E. L., K. E. H., G. S., K. F. H., J. G. F.). The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sunovion.

Publisher Copyright:
© 2022 American College of Chest Physicians

Keywords

COPD
overdose
prospective cohort study
suicide deaths
tobacco smoking

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.chest.2022.09.022

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@article{1eea557b4e094020a5f12d487764fef0,

title = "Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort",

abstract = "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.",

keywords = "COPD, overdose, prospective cohort study, suicide deaths, tobacco smoking",

author = "{COPDGene Investigators} and Adviento, {Brigid A.} and Regan, {Elizabeth A.} and Make, {Barry J.} and Han, {Mei Lan K.} and Foreman, {Marilyn G.} and Iyer, {Anand S.} and Bhatt, {Surya P.} and Victor Kim and Jessica Bon and Xavier Soler and Kinney, {Gregory L.} and Hanania, {Nicola A.} and Lowe, {Katherine E.} and Holm, {Kristen E.} and Yohannes, {Abebaw M.} and Gen Shinozaki and Hoth, {Karin F.} and Fiedorowicz, {Jess G.} and Crapo, {James D.} and Silverman, {Edwin K.} and Beaty, {Terri H.} and Castaldi, {Peter J.} and Cho, {Michael H.} and DeMeo, {Dawn L.} and {El Boueiz}, Adel and Auyon Ghosh and Hayden, {Lystra P.} and Hersh, {Craig P.} and Jacqueline Hetmanski and Hobbs, {Brian D.} and Hokanson, {John E.} and Wonji Kim and Nan Laird and Christoph Lange and Lutz, {Sharon M.} and McDonald, {Merry Lynn} and Dmitry Prokopenko and Matthew Moll and Jarrett Morrow and Dandi Qiao and Aabida Saferali and Phuwanat Sakornsakolpat and Wan, {Emily S.} and Charlene McEvoy and Joseph Tashjian and Christine Wendt and Kunisaki, {Ken M.} and Joanne Billings and Abbie Begnaud and Tadashi Allen",

note = "Funding Information: The project described was supported by Award Number U01 HL089897 and Award Number U01 HL089856 from the National Heart, Lung, and Blood Institute . The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sunovion. Funding Information: The authors have reported to CHEST the following: B. J. M. reports grants or contracts paid to the institution from the NIH, American Lung Association, Department of Defense, and Astra Zeneca. He reports royalties from Wolters Kluwer Health (Up-To-Date) and consulting fees from Astra Zeneca and Third Pole. He has received honoraria or speaking fees from Astra Zeneca, Mt. Sanai, Web MD, Novartis, the American College of Chest Physicians, Projects in Knowledge, Eastern Pulmonary Society, Optimum Patient Care Global Limited, GlaxoSmithKline, Boston University Medical Center and Integritas Communications. He has served on monitoring or advisory boards for Spiration, GlaxoSmithKline, Mt. Sinai, Boehringer Ingelheim, Mylan, Quintiles, University of Wisconsin, Baystate Medical Center and AstraZeneca. M. K. H. reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, Regeneron, United Therapeutics, UpToDate, Altesa Biopharma, Medscape and Integrity. She has received either in kind research support or funds paid to the institution from the NIH, Novartis, Sunovion, Nuvaira, Sanofi, Astrazeneca, Boehringer Ingelheim, Gala Therapeutics, and Biodesix. She has participated in Data Safety Monitoring Boards for Novartis and Medtronic with funds paid to the institution. She has received stock options from Meissa Vaccines and Altesa Biopharma. A. S. I. reports consulting fees from AstraZeneca and speaking fees from Ascension St. Vincent's. S. P. B. has received consulting fees from Boehringer Ingelheim and Sanofi and CME fees from IntegrityCE. V. K. has received consultancy fees from Gala Therapeutics and AstraZeneca. X. S. is a full-time employee of Regeneron Pharmaceuticals, Inc. and owns restricted shares and or stock options. A. M. Y. has received a consultation fee from Astrazeneca. None declared (B. A. A., E. A. R., M. G. F., J. B., G. L. K., N. A. H., K. E. L., K. E. H., G. S., K. F. H., J. G. F.). The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sunovion. Publisher Copyright: {\textcopyright} 2022 American College of Chest Physicians",

year = "2023",

month = feb,

doi = "10.1016/j.chest.2022.09.022",

language = "English (US)",

volume = "163",

pages = "292--302",

journal = "CHEST",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "2",

}

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 - McEvoy, Charlene

AU - Tashjian, Joseph

AU - Wendt, Christine

AU - Kunisaki, Ken M.

AU - Billings, Joanne

AU - Begnaud, Abbie

AU - Allen, Tadashi

N1 - Funding Information: The project described was supported by Award Number U01 HL089897 and Award Number U01 HL089856 from the National Heart, Lung, and Blood Institute . The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sunovion. Funding Information: The authors have reported to CHEST the following: B. J. M. reports grants or contracts paid to the institution from the NIH, American Lung Association, Department of Defense, and Astra Zeneca. He reports royalties from Wolters Kluwer Health (Up-To-Date) and consulting fees from Astra Zeneca and Third Pole. He has received honoraria or speaking fees from Astra Zeneca, Mt. Sanai, Web MD, Novartis, the American College of Chest Physicians, Projects in Knowledge, Eastern Pulmonary Society, Optimum Patient Care Global Limited, GlaxoSmithKline, Boston University Medical Center and Integritas Communications. He has served on monitoring or advisory boards for Spiration, GlaxoSmithKline, Mt. Sinai, Boehringer Ingelheim, Mylan, Quintiles, University of Wisconsin, Baystate Medical Center and AstraZeneca. M. K. H. reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, Regeneron, United Therapeutics, UpToDate, Altesa Biopharma, Medscape and Integrity. She has received either in kind research support or funds paid to the institution from the NIH, Novartis, Sunovion, Nuvaira, Sanofi, Astrazeneca, Boehringer Ingelheim, Gala Therapeutics, and Biodesix. She has participated in Data Safety Monitoring Boards for Novartis and Medtronic with funds paid to the institution. She has received stock options from Meissa Vaccines and Altesa Biopharma. A. S. I. reports consulting fees from AstraZeneca and speaking fees from Ascension St. Vincent's. S. P. B. has received consulting fees from Boehringer Ingelheim and Sanofi and CME fees from IntegrityCE. V. K. has received consultancy fees from Gala Therapeutics and AstraZeneca. X. S. is a full-time employee of Regeneron Pharmaceuticals, Inc. and owns restricted shares and or stock options. A. M. Y. has received a consultation fee from Astrazeneca. None declared (B. A. A., E. A. R., M. G. F., J. B., G. L. K., N. A. H., K. E. L., K. E. H., G. S., K. F. H., J. G. F.). The COPDGene study (NCT00608764) is also supported by the COPD Foundation through contributions made to an Industry Advisory Committee comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Sunovion. 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

UR - http://www.scopus.com/inward/record.url?scp=85146895780&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85146895780&partnerID=8YFLogxK

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 -

Clinical Markers Associated With Risk of Suicide or Drug Overdose Among Individuals With Smoking Exposure: A Longitudinal Follow-up Study of the COPDGene Cohort

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