Study includes figures for 38 countries up to 2019; smoking said to be major factor
Mortality rates associated with chronic obstructive pulmonary disease (COPD) were declining in men but rising among women in many countries as of 2019, according to a recent study.
This shift is likely related to changes in smoking habits, with smoking generally declining in men but being more variable among women, the researchers noted.
Study data also demonstrated that in general, COPD mortality rates are highest in patients older than 65.
The study, “Chronic obstructive pulmonary disease (COPD) mortality trends worldwide: An update to 2019,” was published in the journal Respirology.
COPD is a leading cause of death and disability worldwide. In 2019, the Global Burden of Disease Study estimated that 3.197 million deaths worldwide could be attributed to it.
But the burden of the chronic lung disease varies substantially across the world, with greater burden thought to lie among low- or middle-income countries.
Using data from the World Health Organization gathered up to 2019, researchers aimed to provide an updated analysis of COPD-associated mortality worldwide.
The team analyzed certified COPD deaths between 1994–2019, or the last available data in a given country. Overall, 38 countries were included in the analysis, including 22 in Europe, 10 in the Americas, and six others, namely Australia, Hong Kong, Israel, Japan, the Republic of Korea, and New Zealand. These countries were selected based on the availability and quality of relevant data, the researchers noted.
In the analysis, age-standardized mortality rates between 2005–2007 were compared with those seen between 2015–2017.
In the European Union, overall COPD mortality rates decreased by 16.3% in men but increased by 12.7% in women. In the U.S., men saw a 7.8% decline in mortality rates, whereas in women they increased by 2.1%.
Among Latin American and Asian countries, general declines in mortality were observed for both sexes. In Australia, a 21.1% increase in mortality was observed in women.
The highest rates of COPD-related mortality for men between 2015–2017 were seen in Hungary, occurring in 34.5 per 100,000 individuals. For women, the highest mortality rates were observed in Denmark, occurring in 19 per 100,000 individuals. The lowest rates for both sexes occurred in Japan, with an incidence of 5 per 100,000 individuals in men and 0.9 per 100,000 individuals for women.
In most countries, mortality rates among individuals ages 65 and older reflected the overall rate, suggesting that most COPD-associated deaths occurred in older individuals. But data suggested that COPD mortality may be on the rise among younger patients too, especially women in some countries.
Overall, the findings suggest that COPD mortality is showing a “steady decrease in most countries for men, whilst a plateau or an increase was observed in a considerable number of countries for women,” the researchers wrote.
While COPD-associated mortality rates have historically been higher in men — and still are, for the most part — the gap “has become less evident over the last decades in many countries.”
In Sweden, female mortality rates exceeded those seen in men during the 2015–2017 period. In coming years, this might also be observed in other countries, the team noted.
The total of estimated annual deaths for the 38 included countries was 537,000 during 2015–2017 — a number that is less than 20% of the global 2019 estimate from the Global Burden of Disease project, which estimated nearly 3.2 million deaths.
This discrepancy could be partly explained by the data sources used in the study. For the analysis, researchers relied on certified death certificates to ascertain COPD mortality. Country-by-country differences in reporting practices could influence data reliability.
While researchers aimed to bypass this limitation by only including countries with enough high-quality records, that caused a reliance on more large, middle- to high-income nations, making it one the study’s limitations.
“More attention must be paid to small, particularly middle-income countries,” the researchers wrote.
According to researchers, various factors are likely involved in the observed trends, including changes in exposure to pollution or toxins and advancements in the clinical management of COPD.
As smoking is the leading cause of COPD, changing trends in tobacco use likely play a major role. While smoking has generally declined among men, trends in women are more variable and are linked to age and income level.
Other risk factors, like environmental exposures, chronic respiratory infections, and poorly controlled asthma may also disproportionately affect women, the researchers noted.
Overall, despite initiatives to lower tobacco use and improve air quality, “COPD still remains a leading cause of death and disability,” the researchers wrote, noting that lower-income countries may be disproportionately affected.
“Therefore, assessment of COPD mortality trends is of utmost importance to understand factors playing a major role in this context, to serve as a reference to allow informed policy-making,” the team wrote.
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