Beyond respiratory infections: infection-related hospitalisation in individuals with COPD from a community-based cohort

Infections are a major contributor to morbidity and hospitalisation in chronic obstructive pulmonary disease (COPD). However, population-based evidence on infection-related hospitalisation, particularly beyond respiratory infections, remains limited. This study examined the incidence of infections and the risk of infection-related hospitalisation associated with COPD in a community-based cohort. We conducted a population-based cohort study among adults aged ≥ 40 years in suburban Shanghai. COPD was ascertained using electronic medical records and baseline surveys. Infection events were identified from an integrated healthcare information system using ICD-10 codes. Incidence densities were calculated per 1,000 person-years. Negative binomial regression was applied for total infections, and negative binomial hurdle models were used for infection-related hospitalisations to account for overdispersion and excess zeros. Among 32,236 participants followed for 250,397 person-years, 4,277 (13.3%) had COPD. After multivariable adjustment, COPD was associated with a higher incidence density of total infections (IRR = 1.76, 95% CI: 1.71–1.82). COPD was associated with increased odds of infection-related hospitalisation (OR = 2.08, 95% CI: 1.87–2.31), including respiratory infections (OR = 2.68, 95% CI: 2.36–3.05) and non-respiratory infections (OR = 1.43, 95% CI: 1.22–1.66). Among individuals with at least one infection-related hospitalisation, COPD was associated with higher hospitalisation frequencies for overall infection (IRR = 1.69, 95% CI: 1.37–2.09) and respiratory infection (IRR = 2.10, 95% CI: 1.60–2.74). COPD is associated with an increased risk of infection-related hospitalisation in a community-based cohort, extending beyond respiratory infections. Infection prevention should be integrated into comprehensive COPD management. Not applicable.