Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • COVID-19 submission information
    • Peer reviewer login
  • Alerts
  • Podcasts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • COVID-19 submission information
    • Peer reviewer login
  • Alerts
  • Podcasts
  • Subscriptions

International trends in COPD mortality, 1995–2017

Joannie Lortet-Tieulent, Isabelle Soerjomataram, José Luis López-Campos, Julio Ancochea, Jan Willem Coebergh, Joan B. Soriano
European Respiratory Journal 2019 54: 1901791; DOI: 10.1183/13993003.01791-2019
Joannie Lortet-Tieulent
1Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Joannie Lortet-Tieulent
  • For correspondence: tieulentj@fellows.iarc.fr
Isabelle Soerjomataram
1Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Isabelle Soerjomataram
José Luis López-Campos
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
3Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for José Luis López-Campos
Julio Ancochea
4Instituto de Investigación, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jan Willem Coebergh
5Dept of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Jan Willem Coebergh
Joan B. Soriano
2Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
4Instituto de Investigación, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Joan B. Soriano
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

In our international study over 1995–2017, COPD mortality rates declined in most countries. Yet, in females, they remained stable in North America and increased in six countries in Europe. The number of deaths increased or remained stable in most countries. http://bit.ly/2niUQ8d

To the Editor:

Since 2016, chronic obstructive pulmonary disease (COPD) has been the third-leading cause of death worldwide, with an estimated 3 million deaths (5.3% of all deaths), but with large regional variations [1]. Observed data from high-income countries (HICs) [2–5] and modelled data in two global studies [6, 7] have reported declines in COPD mortality rates since the 1990s. Globally, since 2006, modelled COPD mortality rates decreased by 21% [8]. Yet, little is known about observed trends in COPD mortality in Latin America, and more recently in Oceania and Europe.

Mortality data can be expressed in many ways, for different purposes. Absolute death counts are useful to clinicians and for local use; crude mortality rates allow comparisons with other conditions, and regional healthcare planning. Finally, standardised mortality rates are valuable for comparison between countries and/or period by adjusting for differences in the demographic composition. For our study, COPD death counts were extracted from the World Health Organization (WHO) mortality database [9] between 1995 and 2017, using International Classification of Disease-10 codes of chronic bronchitis (J40–J42), emphysema (J43) and other COPD (J44) [5]. No redistribution of ill-defined codes was performed. Countries with ≥2 million inhabitants in 2010 and vital statistics covering >90% of their national population, a proportion of ill-defined causes of death <10% since 2000, data until at least 2013, for >10 continuous years by sex and <5% of unknown age at COPD death were selected. Corresponding population data were obtained from the United Nations population 2017 revision estimates [10].

COPD age-standardised mortality rates were computed for ages 50–84 years using the world standard population, corrected for unknown age at death. The Joinpoint regression programme (version 4.7.0.0; https://surveillance.cancer.gov/joinpoint/) was used to model temporal changes in mortality rates. It performs a linear regression of the observed rates versus years and then iteratively tests (with a Monte Carlo Permutation) whether break points (so-called joinpoints) would improve the fitness of the model. The selected model is the most parsimonious one and provides an estimation of the annual percentage change in rates based on the slope of the linear trend between two joinpoints (or the first/last observation).

24 countries (six in Latin America and the Caribbean; two in each of North America, Asia and Oceania; and 12 in Europe), covering 12% of the world's population, were included in this study. In total, close to 3.36 million COPD deaths (56% male) were analysed. Throughout 1995–2017, in Latin America and the Caribbean, Asia and Oceania, COPD mortality rates, in both sexes, declined or remained stable (figure 1a). For instance, rates declined by −5.2% and −5.6% per year in Costa Rica, in males and females, respectively. The exceptions were the increasing rates observed among Cuban (+1.5% per year) and Australian (+2.4% per year since 2009) females. In Europe, mortality rates have also been declining among males in most countries, but remained stable in Hungary (since 2005) and increased in the Czech Republic and Croatia. Meanwhile, among females, COPD mortality rates have been increasing in half of the studied countries, from +2% per year in Austria to +4.2% or +4.8% per year in the Czech Republic and Hungary, respectively.

FIGURE 1
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1

Trends in chronic obstructive pulmonary disease (COPD) mortality by region and sex, ages 50–84 years. a) Age-standardised mortality rates; b) number of deaths. Death counts were smoothed with a moving average of 30% of the values. W: world; AUS: Australia; AUT: Austria; CAN: Canada; CHL: Chile; COL: Colombia; CRI: Costa Rica; CUB: Cuba; CZE: Czech Republic; ESP: Spain; FIN: Finland; GBR: United Kingdom; HRV: Croatia; HUN: Hungary; ISR: Israel; ITA: Italy; KGZ: Kyrgyzstan; LTU: Lithuania; LVA: Latvia; MEX: Mexico; NZL: New Zealand; ROU: Romania; SVK: Slovakia; USA: United States of America; VEN: (Bolivarian Republic of) Venezuela; N. Am.: North America; Oc.: Oceania; N./W. Europe: Northern and Western Europe; E./S. Europe: Eastern and Southern Europe.

During the latest 2 years available (circa 2016), COPD mortality rates were highest in Hungary and Kyrgyzstan among males (141 and 135 deaths per 100 000 person-years, respectively) and in the USA and Hungary among females (75 and 71 deaths per 100 000 person-years, respectively). COPD mortality rates were lowest among males in Italy, Costa Rica and Israel (32, 39 and 39 deaths per 100 000 person-years, respectively) and among females in Latvia, Spain, and Lithuania (6, 9 and 10 deaths per 100 000 person-years, respectively). Despite the observed convergence between males and females in 18 out of 24 countries over the whole study period, COPD mortality rates remained twice as high in males as in females in each country, except in the USA, New Zealand and the UK, where rates almost matched.

Finally, assessing changes in absolute number of deaths between 2000 and 2015, the number of COPD deaths increased by >10% in 11 countries, particularly in Latin America, North America, Eastern and Southern Europe (almost doubling in the Czech Republic and Croatia), and decreased by >10% in six countries (40% and 50% in Lithuania and Kyrgyzstan, respectively). In the other seven countries COPD deaths were more or less stable (figure 1b).

In this international study, with few exceptions (mainly among European females), COPD mortality rates have been declining (markedly, for some countries). For instance, mortality rates were halved in 15 years in both sexes in Costa Rica, Kyrgyzstan and Lithuania. Nevertheless, COPD death counts increased in almost half and remained stable in a quarter of the countries studied.

COPD may result from longstanding exposure to tobacco smoking, occupational chemical substances, indoor and outdoor air pollution, with a role played by genetic susceptibility, poverty, stunting and bronchial infections such as tuberculosis [2, 5, 11–13]. The contribution of these factors depends on the socioeconomic level of the countries. Tobacco smoking and second-hand smoking are leading risk factors in HICs, while poverty, environmental exposures and early-life events predominate in low- and middle-income countries [14]. As evidence, in 2012, in Kyrgyzstan, where 3% of females smoked, the female COPD mortality rate was ∼70 per 100 000, similar to that in the UK which had a decreasing yet very high female smoking prevalence of 20% [15]. The declines in the COPD mortality rates in the highest-income nations probably reflect previous declines in smoking prevalence in addition to recent progress in the diagnosis and management [16]. In fast-growing economies, such as in Latin America, reductions in poverty probably also contribute [6, 17]. The narrowing of the gender gap in COPD mortality rates in three-quarters of the countries (mostly HICs) was previously reported in Europe [4]. The same phenomenon was observed in tobacco-related cancer mortality [18], supporting the strong association between tobacco smoking and COPD mortality in HICs. In countries where females have been smoking as much and as long as males (e.g. USA, New Zealand and the UK) [15] female mortality from COPD became very similar to that of males.

In spite of declining COPD mortality rates in the majority of the countries studied, the number of COPD deaths has actually been increasing, or at the minimum stabilising, due to population growth and ageing (e.g. in Colombia, Mexico, Venezuela and the USA). The number of COPD deaths will probably grow further due to greater exposure to risk factors such as outdoor air pollution in the growing urban populations [19, 20], and the benefits of additional declines in mortality from cardiovascular disease and acute infection [16].

The strengths of this study include the extensive international coverage of COPD mortality, with up-to-date high-quality observed data. Nevertheless, several limitations are worth mentioning. Firstly, underdiagnosis and under-reporting of COPD are universal [16], probably more so in older people, especially in middle-income countries. However, restricting the analysis to ages 50–69 years led to similar conclusions (data not shown), supporting the robustness of our analysis on ages 50–84 years. Secondly, expanding the analysis to the contributing causes of death mentioned on the death certificates would give a better picture of the mortality attributable to COPD and should be pursued [16]. Therefore, our study probably underestimates the true mortality burden of COPD. In addition, we acknowledge the reduced global reach of our study due to the scarcity of high-quality mortality registration in most low- and middle-income countries such as China and India (population coverages of 4% and 8%, respectively) and some HICs including Germany and Japan (proportions of ill-defined causes of death of 11% and 16%, respectively). Another populous country, the Russian Federation, combines COPD and asthma deaths in reporting to the WHO mortality database, and was therefore excluded. Increasing high-quality and availability of mortality data in low- and middle-income countries, with escalating issues related to urbanisation and higher exposure to air pollution than in HICs, would offer valuable insight. Finally, comprehensive information on differences in diagnostic practices and access to treatment for COPD could elucidate disparities between countries with otherwise similar profiles of risk factor exposure.

In most of the countries studied, declines in COPD mortality rates were observed, but were not mirrored by reductions in the number of COPD deaths. Necessary steps to curtail the future burden are to regionally tailor primary prevention measures to decrease exposure to the main COPD risk factors, to cope with multi-morbidity [21], and to expand access to diagnosis and treatment [14, 22].

Shareable PDF

Supplementary Material

This one-page PDF can be shared freely online.

Shareable PDF ERJ-01791-2019.Shareable

Footnotes

  • Disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

  • Conflict of interest: J. Lortet-Tieulent has nothing to disclose.

  • Conflict of interest: I. Soerjomataram has nothing to disclose.

  • Conflict of interest: J.L. López-Campos reports personal fees and non-financial support from AstraZeneca, CSL Behring and Ferrer, and grants, personal fees and non-financial support from Boehringer Ingelheim, Chiesi, Esteve, GebroPharma, GlaxoSmithKline, Grifols, Menarini, Novartis, Rovi and Teva, outside the submitted work.

  • Conflict of interest: J. Ancochea has nothing to disclose.

  • Conflict of interest: J.W. Coebergh has nothing to disclose.

  • Conflict of interest: J.B. Soriano participated in speaking activities, advisory committees and consultancies during the period 2014–2019 sponsored by: Almirall, AstraZeneca, Boehringer-Ingelheim, CHEST, Chiesi, ERS, GEBRO, Grifols, GSK, Linde, Lipopharma, Mundipharma, Novartis, Pfizer, RiRL, Rovi, Sandoz, SEPAR and Takeda. J.B. Soriano declares not receiving ever, directly or indirectly, funding from the tobacco industry or its affiliates.

  • Received September 6, 2018.
  • Accepted September 25, 2019.
  • Copyright ©ERS 2019
https://www.ersjournals.com/user-licence

References

  1. ↵
    World Health Organization. Projections of Mortality and Causes of Death. Date last accessed: November 11, 2019. Date last updated: October 2018. www.who.int/healthinfo/global_burden_disease/projections/en/
  2. ↵
    1. Adair T,
    2. Hoy D,
    3. Dettrick Z, et al.
    100 years of mortality due to chronic obstructive pulmonary disease in Australia: the role of tobacco consumption. Int J Tuberc Lung Dis 2012; 16: 1699–1705. doi:10.5588/ijtld.12.0251
    OpenUrlPubMed
    1. Pham TM,
    2. Ozasa K,
    3. Kubo T, et al.
    Age-period-cohort analysis of chronic obstructive pulmonary disease mortality in Japan, 1950–2004. J Epidemiol 2012; 22: 302–307. doi:10.2188/jea.JE20110092
    OpenUrlCrossRefPubMed
  3. ↵
    1. López-Campos JL,
    2. Ruiz-Ramos M,
    3. Soriano JB
    . Mortality trends in chronic obstructive pulmonary disease in Europe, 1994–2010: a joinpoint regression analysis. Lancet Respir Med 2014; 2: 54–62. doi:10.1016/S2213-2600(13)70232-7
    OpenUrl
  4. ↵
    1. Ford ES
    . Trends in mortality from COPD among adults in the United States. Chest 2015; 148: 962–970. doi:10.1378/chest.14-2311
    OpenUrl
  5. ↵
    1. Burney PG,
    2. Patel J,
    3. Newson R, et al.
    Global and regional trends in COPD mortality, 1990–2010. Eur Respir J 2015; 45: 1239–1247. doi:10.1183/09031936.00142414
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Soriano JB,
    2. Abajobir AA,
    3. Abate KH, et al.
    Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017; 5: 691–706. doi:10.1016/S2213-2600(17)30293-X
    OpenUrl
  7. ↵
    GBD Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151–1210. doi:10.1016/S0140-6736(17)32152-9
    OpenUrlCrossRefPubMed
  8. ↵
    World Health Organization. WHO Mortality Database. Date last accessed: November 11, 2019. Date last updated: May 1, 2019. www.who.int/healthinfo/mortality_data/en/
  9. ↵
    United Nations DESA/Population Division. World Population Prospects 2019. Date last accessed: November 11, 2019. Date last updated: June 2017. https://esa.un.org/unpd/wpp/Download/Standard/Population/
  10. ↵
    1. Burney P,
    2. Jithoo A,
    3. Kato B, et al.
    Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty – a BOLD analysis. Thorax 2014; 69: 465–473. doi:10.1136/thoraxjnl-2013-204460
    OpenUrlAbstract/FREE Full Text
  11. European Respiratory Society. European Lung White Book. Sheffield, European Respiratory Society, 2013.
  12. ↵
    1. Taghizadeh N,
    2. Vonk JM,
    3. Boezen HM
    . Lifetime smoking history and cause-specific mortality in a cohort study with 43 years of follow-up. PLoS One 2016; 11: e0153310. doi:10.1371/journal.pone.0153310
    OpenUrl
  13. ↵
    1. Halpin DMG,
    2. Celli BR,
    3. Criner GJ, et al.
    It is time for the world to take COPD seriously: a statement from the GOLD board of directors. Eur Respir J 2019; 54: 1900914. doi:10.1183/13993003.00914-2019
    OpenUrlAbstract/FREE Full Text
  14. ↵
    1. Ng M,
    2. Freeman MK,
    3. Fleming TD, et al.
    Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 2014; 311: 183–192. doi:10.1001/jama.2013.284692
    OpenUrlCrossRefPubMedWeb of Science
  15. ↵
    1. Vogelmeier CF,
    2. Criner GJ,
    3. Martinez FJ, et al.
    Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD executive summary. Eur Respir J 2017; 49: 1700214. doi:10.1183/13993003.00214-2017
    OpenUrlAbstract/FREE Full Text
  16. ↵
    1. Burney P,
    2. Jarvis D,
    3. Perez-Padilla R
    . The global burden of chronic respiratory disease in adults. Int J Tuberc Lung Dis 2015; 19: 10–20. doi:10.5588/ijtld.14.0446
    OpenUrlCrossRefPubMed
  17. ↵
    1. Lortet-Tieulent J,
    2. Renteria E,
    3. Sharp L, et al.
    Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988–2010. Eur J Cancer 2015; 51: 1144–1163. doi:10.1016/j.ejca.2013.10.014
    OpenUrlCrossRefPubMed
  18. ↵
    1. Mannino DM,
    2. Buist AS
    . Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370: 765–773. doi:10.1016/S0140-6736(07)61380-4
    OpenUrlCrossRefPubMedWeb of Science
  19. ↵
    1. López-Campos JL,
    2. Tan W,
    3. Soriano JB
    . Global burden of COPD. Respirology 2016; 21: 14–23. doi:10.1111/resp.12660
    OpenUrlCrossRefPubMed
  20. ↵
    1. Hurst JR,
    2. Dickhaus J,
    3. Maulik PK, et al.
    Global Alliance for Chronic Disease researchers’ statement on multimorbidity. Lancet Glob Health 2018; 6: e1270–e1271. doi:10.1016/S2214-109X(18)30391-7
    OpenUrl
  21. ↵
    1. Soriano JB
    . The evolution of COPD species; or, something is changing for good in COPD. Eur Respir J 2019; 53: 1900762. doi:10.1183/13993003.00762-2019
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top
View this article with LENS
Vol 54 Issue 6 Table of Contents
European Respiratory Journal: 54 (6)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
International trends in COPD mortality, 1995–2017
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
International trends in COPD mortality, 1995–2017
Joannie Lortet-Tieulent, Isabelle Soerjomataram, José Luis López-Campos, Julio Ancochea, Jan Willem Coebergh, Joan B. Soriano
European Respiratory Journal Dec 2019, 54 (6) 1901791; DOI: 10.1183/13993003.01791-2019

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
International trends in COPD mortality, 1995–2017
Joannie Lortet-Tieulent, Isabelle Soerjomataram, José Luis López-Campos, Julio Ancochea, Jan Willem Coebergh, Joan B. Soriano
European Respiratory Journal Dec 2019, 54 (6) 1901791; DOI: 10.1183/13993003.01791-2019
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Shareable PDF
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Agora

  • Carbon footprint of respiratory treatments
  • ERS/ATS standards on lung function test interpretation: some limitations
  • Reply: ERS/ATS standards on lung function test interpretation: some limitations
Show more Agora

Research letters

  • Carbon footprint of respiratory treatments
  • ERS/ATS standards on lung function test interpretation: some limitations
  • Reply: ERS/ATS standards on lung function test interpretation: some limitations
Show more Research letters

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Reviewers
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2022 by the European Respiratory Society