Functional and Social Vulnerability in Patients With Chronic Obstructive Pulmonary Disease (COPD) Managed in Primary Care: A Population-Based Cohort Study.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are increasingly recognized as a heterogeneous population in whom prognosis depends not only on respiratory impairment but also on functional decline, multimorbidity, and social vulnerability. However, the prognostic value of routinely recorded functional and social vulnerability markers in primary care has been insufficiently investigated. OBJECTIVE: The objective of the study is to determine whether routinely recorded functional and social vulnerability markers are independently associated with all-cause mortality among patients with spirometry-confirmed COPD managed in primary care. METHODS: We conducted a population-based retrospective cohort study using electronic health records from primary care centers in Catalonia, Spain. Adults with spirometry-confirmed COPD were followed from 2019 to 2023. Functional and social vulnerability markers included living alone, home-care program (ATDOM) enrollment, functional dependency, nursing home residence, dementia, and long-term respiratory support. Multivariable logistic regression was performed to identify independent predictors of all-cause mortality. RESULTS: Among 2,056 patients, 558 (27.1%) died during follow-up. Patients who died were older, predominantly male, and had a greater burden of comorbidity and functional vulnerability. After adjustment, home-care program enrollment, functional dependency, and nursing home residence remained independently associated with mortality, together with age, male sex, smoking, previous exacerbations, heart failure, atrial fibrillation, chronic kidney disease, and active malignancy. Physical activity and higher FEV₁ were independently associated with lower mortality. CONCLUSIONS: Routinely recorded functional and social vulnerability markers independently identified patients with COPD at increased risk of death beyond traditional clinical predictors. Their incorporation into routine primary care assessment may improve risk stratification and facilitate earlier identification of high-risk patients for personalized multidisciplinary care.