Determinants of All-Cause Mortality in Spirometry-Confirmed COPD in Primary Care: A Population-Based Multidimensional Cohort Study

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide and a systemic condition in which outcomes are influenced by respiratory impairment, multimorbidity, exacerbation burden, and functional status. This study aimed to identify multidimensional determinants of all-cause mortality in a population-based cohort of primary care patients with spirometry-confirmed COPD. Methods: We conducted a retrospective population-based cohort study using electronic health records from primary care in the Lleida health region (Catalonia, Spain). Adult patients with spirometry-confirmed COPD (FEV1/FVC < 0.70) between 2019 and 2023 were included. Baseline demographic, clinical, spirometric, functional, and social variables were extracted. Exacerbations in the year prior to baseline were classified as 0, 1, or ≥2 events (and, where available, as moderate vs. severe) using a prespecified operational definition. The primary outcome was all-cause mortality during follow-up (censoring date: 31 December 2023). Time-to-event analyses were performed using Cox proportional hazards models. Results: A total of 2056 patients were included (median age 71 years; 78.4% male). During follow-up, 558 patients died (27.1%). Independent predictors of mortality included male sex, increasing age, current smoking, and prior exacerbations, whereas sufficient physical activity and better lung function (FEV1 % predicted) were protective. Conclusions: Mortality in spirometry-confirmed COPD managed in primary care is driven by a multidimensional vulnerability profile beyond lung function alone. Integrating respiratory, clinical, and functional determinants may improve risk stratification and management in chronic lung disease.