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All multivariate models were adjusted for covariates measured at Exam 2, including socio-demographics (age, sex, residential area, household income), lifestyle factors (alcohol consumption, regular physical activity, cumulative smoking exposure measured by pack-years), and clinical history [initial COPD treatment regimen (LABA, LAMA, or ICS use), history of pneumonia in the previous year, and history of severe exacerbation in the previous year] as a priori selected covariates known to be associated with both exposure and outcomes

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