Association of chronic obstructive pulmonary disease with risk of lung cancer in individuals aged 40 years and older: A cross-sectional study based on NHANES 2013-2018

Background

It remains unclear whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer after excluding confounding factors such as smoking, age, gender, body mass index (BMI), comorbidities, etc.

Methods

Data from 11,440 participants (≥ 40 years old) in the National Health and Nutrition Examination Survey (NHANES) 2013-2018 were analyzed. Weighted multivariable logistic regression models were used to assess the association between COPD and lung cancer risk. Subgroup analyses were based on age, gender, body mass index (BMI), and smoking.

Results

This study included 660 COPD patients and 10,780 participants without COPD. The prevalence of lung cancer was significantly higher in COPD patients compared to participants without COPD (3.39% vs 0.14%). After adjusting for confounding factors, COPD was associated with a significantly increased risk of lung cancer (OR, 12.24, 95% CI, 4.99-30.06, p < 0.001). This association remained significant in all subgroups, particularly in individuals aged > 65 years (OR, 20.05, 95% CI, 6.85-58.72, p < 0.001), smokers (OR, 19.38, 95% CI, 2.02-185.66, p = 0.010), males (OR, 17.39, 95% CI, 5.28-57.31, p < 0.001), individuals who quit smoking within 10 years (OR, 12.86, 95% CI, 2.59, 63.99, p = 0.002), and individuals with a BMI > 25 kg/m2 (OR, 14.56, 95% CI, 3.88-54.69, p < 0.001).

Conclusions

COPD is an independent risk factor for lung cancer, especially in certain subgroups. The combination of COPD and smoking greatly amplifies the lung cancer risk. These findings highlight the importance of early lung cancer screening in COPD patients.

Methods
The data analyzed in this study are from the National Health and Nutrition Examination Survey (NHANES), which are publicly available and can be downloaded from the NHANES website: http://www.cdc.gov/nchs/nhanes.htm

We obtained data from the NHANES database website for the three cycles of 2013-2014, 2015-2016, and 2017-2018. Data analysis, including baseline characteristic distribution, weighted multivariable logistic regression models,  and subgroup analysis, was conducted using StataMP17.0.