Prevalence and Impact of Social Frailty in Patients with Chronic Obstructive Pulmonary Disease

Kuniaki Hirai,1 Akihiko Tanaka,1 Naruhito Oda,2 Keisuke Kaneko,3 Yoshitaka Uchida,1 Tomoki Uno,1 Shin Ohta,1 Tetsuya Homma,1 Fumihiro Yamaguchi,4 Shintaro Suzuki,1 Hironori Sagara1 1Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan; 2Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan; 3Department of Medicine, Division of Respiratory Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan; 4Department of Medicine, Division of Respiratory Medicine, Showa University Fujigaoka Hospital, Kanagawa, JapanCorrespondence: Kuniaki Hirai, Department of Medicine, Division of Respiratory Medicine and Allergology, Institute/University/Hospital: Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan, Tel +81-3-3784-8000, Fax +81-3-3784-8742, Email hiraik@med.showa-u.ac.jpBackground: Patients with chronic obstructive pulmonary disease (COPD) are more inclined to have a high level of social vulnerability due to their physical and psychological burden. However, to date, there have been no study on social frailty in patients with COPD. This study aimed to investigate the prevalence, characteristics, and impact of social frailty in patients with COPD.Methods: Social frailty was assessed using five items in a questionnaire. A patient was diagnosed with social frailty if responses to two or more items were positive. Four hundred and five patients with COPD were assessed for social frailty, dyspnea, and appetite. We also prospectively examined the number of acute exacerbation and unexpected hospitalization for 1 year.Results: Thirty-six percent of patients with COPD had social frailty. They had reduced appetite and more severe dyspnea [Simplified Nutritional Appetite Questionnaire score: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.69‒0.95, p < 0.01; modified Medical Research Council score: OR 1.42, 95% CI 1.05‒1.93, P = 0.02] than patients without social frailty. Social frailty was not a risk factor for moderate acute exacerbation of COPD but a risk factor for severe acute exacerbation and all-cause unexpected hospitalization (severe acute exacerbation: β, standardized regression coefficient: 0.13, 95% CI 0.01‒0.25, P = 0.04, unexpected hospitalization: β 0.17, 95% CI 0.05‒0.29, P = 0.01).Conclusion: The prevalence of social frailty is 36%; however, social frailty has a marked clinical impact in patients with COPD.Keywords: social frailty, chronic obstructive pulmonary disease, social robustness