{"doi":"10.1101/2025.01.17.25320745","title":"Determinants of COPD Stage Progression and Regression: a Markov Transition Analysis of The COPDGene Cohort","abstract":"ABSTRACT Rationale Chronic obstructive pulmonary disease (COPD) is a leading cause of death but with variable progression. Objective Estimate factors influencing transition rates between PRISm and GOLD stages. Methods Using a Markov multistate model, transition rates between GOLD-0, PRISm and GOLD-1, GOLD-2 and GOLD 3-4 were estimated for 5,728 US adult ever cigarette users from the COPDGene cohort over 10-years. We calculated one and five-year transition probabilities for progressive and regressive transitions and estimated the mean sojourn time for severity states. Main Results GOLD-1 and PRISm individuals spent the least time in any single stage (GOLD-1: 6 years; PRISm: 7 years). PRISm and GOLD-1 individuals were equally likely to transition to GOLD-2 vs. GOLD-0 (PRISm: HR 1.09, 95% confidence interval [CI] 0.90-1.33, GOLD-1 (HR 1.15, 95%CI 0.93-1.42) per five-year period, but rarely transition between PRISm and GOLD-1. Individuals at GOLD-0 were equally likely to progress to GOLD-1 or PRISm (HR 1.11, 95%CI 0.93-1.31) but the transient time for this stage was the longest of any GOLD stage (16 years, 95%CI 15.2-17.3). GOLD-2 was the most likely stage to progress (HR 2.4, 95%CI 1.9-3.02) to GOLD 3-4 vs. regress to GOLD-1. For GOLD-2 individuals, current smoking status (HR 0.84, 95%CI 0.67-1.06) or intensity (HR 0.84, 95%CI 0.54-1.29) was not associated with disease progression. Conclusions GOLD-1 and PRISm are the most transient stages equally likely to regress to GOLD-0 or progress to GOLD-2 and may benefit from smoking cessation interventions. GOLD-2 individuals are the most likely to progress and may benefit most from targeted disease interventions.","journal":"medRxiv","year":2025,"id":557157,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8607,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":424315,"name":"Andrew F. Brouwer","orcid":"0000-0002-3779-5287","position":1,"is_corresponding":false},{"id":218026,"name":"Rafael Meza","orcid":"0000-0002-1076-5037","position":2,"is_corresponding":false},{"id":292839,"name":"David T. Levy","orcid":"0000-0001-5280-3612","position":3,"is_corresponding":false},{"id":496317,"name":"Rossana Torres‐Álvarez","orcid":"0000-0003-3646-7975","position":4,"is_corresponding":false},{"id":250088,"name":"MeiLan K. Han","orcid":"0000-0002-9095-4419","position":5,"is_corresponding":false},{"id":435660,"name":"Luz María Sánchez‐Romero","orcid":"0000-0001-7951-3965","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-19T02:55:17.435961Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}