Four Decades of COPD Mortality Trends: Analysis of Trends and Multiple Causes of Death

Abstract

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of -3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality.

Keywords: COPD; mortality; multiple causes; trends.

Figure 1

Annual specific mortality rates due to chronic obstructive pulmonary disease (COPD) as underlying cause of death in men and women. Galicia, population aged 45 years and over, period 1980–2017.

Figure 2

Annual crude mortality rates due to COPD as underlying cause of death, both overall and in men and women. Galicia, population aged 35 years and over, period 1980–2017.

Figure 3

Standardized mortality rate due to COPD as underlying cause of death, both overall and in men and women, and trend in standardized rates. Galicia, population aged 35 years and over, period 1980–2017.

Figure 4

Ratio of age-standardized mortality rates due to COPD as underlying cause of death, both overall and in men and women, and trend in age-standardized ratios. Galicia, population aged 35 years and over, period 1980–2017.

Figure 5

Crude mortality rates “due to” COPD (COPD as underlying cause: solid line in the figure) and “with” COPD (COPD as underlying cause and as immediate, intermediate, or other process (multiple causes: dotted line in the figure)) on the death certificate, both overall and by sex. Galicia, population aged 35 years and over, period 2015–2017.

Figure 6

Diagram proportionally depicting ICD-10 codes considered as the underlying cause of death, in which COPD is recorded as immediate or intermediate (left), or as other process (right): period 2015–2017. ICD-10 codes included (order of frequency): C34.9: malignant neoplasm of bronchus or lung; I25.9: chronic ischemic heart disease; I21.9: acute myocardial infarction; F03: dementia, unspecified; I48.9: atrial fibrillation; I47: paroxysmal tachycardia; I50.9: heart failure, unspecified; I11.0: hypertensive heart disease; I64: stroke; J98.8: other respiratory disorders; E14.9: diabetes mellitus, unspecified; C67.9: cerebrovascular disease; and C61: malignant neoplasm of prostate. “Rest” includes 170 causes in the figure at left and 247 causes in the figure at right; “n” refers to the number of deaths included in each category.