Meta-Analysis the Association between Chronic Obstructive Pulmonary Disease Comorbidity and COVID-19 Mortality

Pamogsa Ratri Adha Daniyar, Agus Kristiyanto, Setyo Sri Rahardjo


disease that hit the world community at the end of 2019. The risk of death from COVID-19 is highly dependent on age and previous health conditions. COVID-19 severe and critical symptoms are more commonly found in older patients and patients who have chronic comor­bidities such as cardio­vascular disease, hyper­tension, diabetes, including COPD. This study aims to deter­mine the relationship between COPD and mortality of COVID-19 patients in hospitals.

Subjects and Method: This a meta-analysis study using the PRISMA flowchart guidelines. The article search process was carried out between 2020-2021 using databases from PubMed, Google Scholar, Science Direct, BMJ Garuda, SINTA, and National Library. Based on the database, there were 9 articles that met the inclusion criteria. The analysis was carried out using RevMan 5.3 software.

Results: A total of 9 articles reviewed in the meta-analysis showed that comorbid COPD had a statistically significant association with hos­pital mortality of COVID-19 patients (aOR = 1.51; 95% CI= 1.21 to 1.9; p < 0.001).

Conclusion: COPD comorbidities have an increased risk of dying of COVID-19 patients in hospital.

Keywords: CPOD, COVID-19, death, meta-analysis

Correspondence: Pamogsa Ratri Adha Daniyar. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile: +62 852-9060-1552.

Journal of Epidemiology and Public Health (2021), 06(02): 222-231

Full Text:



Alemzadeh-Ansari M (2020). Coronavirus disease 2019 (COVID-19) and cardio-vascular events. Res Cardiovascular Med. 9(1): 1.

Hobbs ALV, Turner N, Omer I, Walker MK, Beaulieu RM, Sheikh M, Spires SS, et al. (2020). Risk factors for mortality and progression to severe COVID-19 disease in the Southeast United States (US). Infect Control Hosp Epidemiol. 1-33.

Le Borgne P, Solis M, Severac F, Merdji H, Ruch Y, Intern KA, Bayle E, et al. (2021). SARS-CoV-2 viral load in nasopharyngeal swabs in the emer-gency department does not predict COVID-19 severity and mortality. Acad Emerg Med. 28(3): 306-313.

Brashers VL (2007). Aplikasi klinis patofi-siologi pemeriksaan dan manajemen (Clinical applications of pathophy-siology examination and manage-ment) Edisi 2. Jakarta: EGC Buku Kedokteran.

Caliskan T (2020). Smoking and comorbi-dities are associated with COVID-19 severity and mortality in 565 patients treated in Turkey. Rev Assoc Med Bras (1992). 66(12): 1679-1684.

Center for Evidence Based Management. (2014). Critical Appraisal Checklist for Cross-Sectional Study.

Cen Y, Chen X, Shen Y, Zhang XH, Lei Y, Xu C, Jiang WR, et al. (2020). Risk factors for disease progression in patients with mild to moderate coronavirus disease 2019—A multi-centre observational study, clinical microbiology and infection. Clin Microbiol Infect. 26(9): 1242–1247.

Cetinkal G, Kocas BB, Ser OS, Kilci H, Keskin K, Ozcan SN, Verdi Y, et al. (2020). Assessment of the modified CHA2DS2VASc risk score in predicting mortality in patients hospitalized with COVID-19. Am J Cardiol. 135: 143-149.

Chen J, Bai H, Liu J, Chen G, Liao Q, Yang J, Wu P, Wei J, Ma D, et. al. (2020). Distinct clinical characteristics and risk factors for mortality in female COVID 19 inpatients: a sex stratified large scale cohort study in Wuhan, China. Clin Infect Dis. 71(12): 3188-3195.

Hippisley-Cox J, Young D, Coupland C, Channon K, Tan PS, Harrison D, et al. (2020). Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people. Heart. 106(19): 1503-1511.

Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, et al. (2020). Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. The Lancet. 1763–1770.

De Rosa FG, Palazzo A, Rosso T, Shbaklo N, Mussa M, Boglione L, Borgogno E, et al. (2021). Risk factors for mortality in COVID-19 hospitalized patients in Piedmont, Italy: Results from the Multicenter, Regional, CORACLE Re-gistry. J Clin Med. 10(9): 1951.

Dixon AE, Peters U (2018). The effect of obesity on lung function. Expert Rev Respir Med. 12(9): 755-767

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, Brown TS, et al. (2020). Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 75(18): 2352-2371. 75 (18): 2352–2371.

Elezkurtaj S, Greuel S, Ihlow J, Michaelis EG, Bischoff P, Kunze CA, Sinn BV, Gerhold M, et al. (2021). Causes of death and comorbidities in hospitalized patients with COVID-19. Sci Rep. 11(1): 4263.

Haroon S, Subramanian A, Cooper J, Anand A, Gokhale K, Byne N, Dhalla S, et al. (2021). Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care. BMC Infect Dis. 21: 262.

Hidayani WR (2020). Faktor faktor risiko yang berhubungan dengan COVID 19. (Risk factors associated with COVID 19). Jurnal Untuk Masyarakat Sehat. 4(2): 120–134. doi: 10.52643/jukmas.v4i2.1015.

Hunter JE, Jensen JL, Rodgers R (2014). The control group and meta-analysis. J Methods Meas Soc Sci. 6(1): 3–21. doi: 10.2458/azu_jmmss.v5i1.18302.

Ilmusiana (2019). Peta Dunia. Ilmusiana. /peta-dunia-hd-2019.html. (diakses 28 Juni 2019)

Junaidin J, Syam Y, Irwan AM (2019). Pengaruh pursed lip breathing dan meniup balon terhadap kekuatan otot pernapasan, saturasi oksigen dan respiratory rate pada pasien PPOK. Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing). 5(1): 31–39. doi: 10.33023/jikep.v5i1.211.

Kemenkes RI (2008). Pedoman pengen-dalian penyakit paru obstruktif kronik (Guidelines for the control of chronic obstructive pulmonary diseases). Keputusan Menteri Kesehatan Republik Indonesia.

Leung JM, Niikura M, Yang CWT, Sin DD (2020). COVID-19 and COPD. Eur Respir J. 56(2): 2002108.

Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, Wang Z et al. (2020). Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 63(3): 364–374.

Magleby R, Lars W, Alex T, Matthew S, Mangala R, Joel P, Para G, et al. (2020). Impact of SARS-CoV-2 viral load on risk of intubation and mortality among hospitalized patients with Coronavirus disease 2019. Clin Infect Dis. ciaa851.

Mikolajewicz N, Komarova SV (2019). Meta-analytic methodology for basic research: A practical guide. Front Physiol. 10: 203

Mostafaei A, Ghojazadeh M, Hajebrahimi S, Abolhasanpour N, Salehi-Pourmehr H (2021). Clinical presentation of Iranian patients affected with COVID-19: A thousand faces disease. Iran J Allergy Asthma Immunol. 20(2): 140-146. doi: 10.18502/ijaai.v20i2.6047.

Mousavizadeh L, Ghasemi S (2020). Genotype and phenotype of COVID-19: Their roles in pathogenesis. J Microbiol Immunol Infect. 54(2): 159-163

Murti B (2018). Prinsip dan metode riset epidemiologi (Principles and methods of epidemiological research). 5th ed. Karanganyar: Program Studi Ilmu Kesehatan Masyarakat.

Nikolakopoulou A (2014). Characteristics of networks of interventions: A description of a database of 186 published networks. PLoS One. 2014; 9(1): e86754.

Oh TK, Song IA (2021). Impact of Coronavirus Disease-2019 on chronic respiratory disease in South Korea: An NHIS COVID-19 database cohort study. BMC Pulm Med. 21(1): 12.

Paldam M (2015). Meta-analysis in a nutshell: techniques and general findings. 1–15. doi: 10.5018/economicsejournal.ja.2015-11.

Pranata R, Soeroto Y, Huang I, Lim, Santoso P, Permana, Lukito AA (2020). Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19. Int J Tuberc Lung Dis. 24(8): 838-843.

Sedgwick P (2013). Meta-analyses: How to read a funnel plot. BMJ. 346: f1342.

Shah P, Owens J, Franklin J, Mehta A, Heymann W, Sewell W, Hill J, et al. (2020). Demographics, comorbidities and outcomes in hospitalized Covid-19 patients in rural southwest Geor-gia. Ann Med. 52(7): 354–360.

Siddaway AP, Wood AM, Hedges LV (2018). How to do a systematic review: A best practice guide for con-ducting and reporting narrative re-views, meta-analyses, and meta-syntheses. Ann Rev Psychol. 70(1): 747–770.

Smith MC, Wrobel JP (2014). Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis. 9: 871–888.

Somani SS, Richter F, Fuster V, Freitas JK, Naik N, Sigel K, Bottinger EP, et al. (2020). Characterization of patients who return to hospital following dis-charge from hospitalization for COVID-19. J Gen Intern Med. 35(10): 2838–2844.

Susilo A, Rumende CM, Pitoyo CW, Santoso WD, Yulianti M, Herikurniawan H, Sinto R, et al. (2020). Coronavirus Disease 2019: Tinjauan literatur ter-kini. Jurnal Penyakit Dalam Indone-sia, 7(1): 45.

Viktorova IB, Zimina VN, Kravchenko AV (2020). Chronic obstructive pulmo-nary disease and HIV-infection. HIV Infect Immunosuppr Dis. 12(4): 23–31. doi: 10.22328/2077-9828-2020-12-4-23-31.

de Vito A, Geremia N, Fiora V, Princic E, Babudieri S, Madeddu G (2020). Clinical features, laboratory findings and predictors of death in hospitalized patients with COVID-19 in Sardinia, Italy. Eur Rev Med Pharmacol Sci. 24(14): 7861-7868.

Walker J, Dolly S, Ng L, Prior-Ong M, Sabapathy K (2020). The role of CPAP as a potential bridge to invasive ventilation and as a ceiling-of-care for patients hospitalized with Covid-19 — An observational study. PLoS One. 15(12): e0244857.

Wang, Dawei, Hu Chang, Zhu Fangfang, Zhang Jing, Wang Binbin, Xiang Hiu, Cheng Zhengshun, Xiong Yong, et al. (2020). Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected Pneumonia in Wuhan, China. JAMA. 323(11): 1061–1069.

Woodall GM (2014). Graphical Depictions of Toxicological Data. in Encyclopedia of Toxicology. 786–795.

World Health Organization (2020). Coronavirus disease 2019 (COVID-19) Situation Report-70. J Intern Med Taiwan. 31(2): 61–66. Available at:

World Health Organization (2020). WHO Director General remark at the media briefing on 2019 nCov. Accessed from

Zhang SY, Lian JS, Hu JH, Zhang XL, Lu YF, Cai H, Gu JQ, et al. (2020). Clinical characteristics of different sub-types and risk factors for the severity of illness in patients with COVID-19 in Zhejiang, China. Infect Dis Poverty 9: 85.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China. The Lancet. 395(10229): 1054–1062.


  • There are currently no refbacks.