High COPD prevalence among socially marginalized hospitalized patients. A pragmatic multicenter prospective cohort study

Background: Tobacco exposure is the main risk factor for chronic obstructive pulmonary disease (COPD), but other risk factors, including low socio-economic status (SES), may also contribute. Danish hospitals have introduced social nurses who support patients with complex health and social conditions. These nurses represent a unique point of contact for identifying hospitalized marginalized individuals who may not have undergone prior diagnostic evaluation for COPD. This study aimed to assess the prevalence of COPD among hospitalized marginalized individuals in contact with social nurses in Denmark. Methods: In this national pragmatic prospective cohort study inpatients in contact with social nurses, underwent spirometry and interview about risk factors, socioeconomic status, and respiratory symptoms, and, if required, underwent further diagnostic work-up. Results: Among 513 patients (median age 52.7 years, 76% males and 442 (86%) without prior diagnosis of COPD), 410 (80%) were current smokers (median pack-years 27.4). The median COPD Assessment Test (CAT) score was 11.0, with 57% having a score above 10. At screening, 470 were able to perform spirometry, and 312 (66%) had airflow obstruction, suggesting COPD. Of these, 75 (24%) patients attended further diagnostic work-up. COPD was confirmed in 38 (52%) of the cases. Additionally, 162 (40%) of all current smokers reported being offered smoking cessation support previously, while 105 (48%) of smokers with obstruction expressed a desire to quit smoking. Interpretation: This study revealed a very high prevalence of undiagnosed COPD among hospitalized socially marginalized individuals. The findings suggest a need for targeted smoking cessation support and COPD screening within this group.