ArticlesLifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study
Introduction
WHO has declared chronic obstructive pulmonary disease (COPD) the fourth most common cause of death worldwide and estimates that it will be the third by 2030.1 8–22% of adults aged 40 years and older have COPD, and it is one of the leading causes of hospitalisation and health care cost incurrence.2, 3, 4 However, despite its substantial effect and campaigns to increase COPD awareness,5 the general public seems to know little about COPD and its public health importance.6 This lack of knowledge might be due to the link between COPD and smoking and the often unspoken belief that COPD patients are the causes of their own misfortune and are undeserving of attention.7 As a result, COPD does not receive the same fundraising, research, and prominence in public policy as do diseases of comparable burden, such as diabetes. For example, a recent analysis by the UK Clinical Research Collaboration8 showed that respiratory disease (including COPD) had the fourth highest disability adjusted life-years but had only the 13th highest research spending—the largest discrepancy between disease burden and spending of all the disorders studied. To help to correct this situation, increased public awareness of COPD and its burden is needed.
Conveying burden of disease to the public is challenging because measures such as prevalence and incidence tend to be abstract and difficult for individuals to relate to. One measure of disease burden that has been well received by the public is lifetime risk or cumulative risk of developing a disease during an individual's lifespan. Lifetime risk estimates have been effectively used to increase public awareness of, and interest in, prevention, screening, and treatment of cancer and other chronic diseases.9, 10, 11 They may also be used by clinicians, researchers, and policy makers to estimate the likelihood that a patient has a chronic disease, to identify individuals at high risk of developing a disease, and to anticipate future burden on the population and plan accordingly.
To the best of our knowledge, there had never been a comprehensive estimate of the lifetime risk of COPD which, we postulated, would be substantial. We undertook a longitudinal population study using health administrative data to estimate the lifetime risk of physician-diagnosed COPD in a complete, multiethnic North American population of about 13 million. We also compared the lifetime risk of other common diseases that have greater public awareness with that of COPD.
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Data sources
Residents of Ontario, Canada have universal public health insurance under the Ontario Health Insurance Plan, the single payer for all medically necessary services. Service details are recorded in health administrative databases, which can be linked on an individual level to provide a complete health services profile for each resident. The only exceptions are details on the provision of prescription drugs, which are only provided to those aged 65 years or older and those receiving social
Results
13 022 536 individuals lived in Ontario at the time of the study, of whom 50·3% were male. A total of 579 466 individuals were identified as having incident physician-diagnosed COPD over the study period. Incidence of COPD increased with age, with an overall incidence of 5·9 cases per 1000 person-years (figure 1).
Lifetime risk of physician-diagnosed COPD was 27·6%. The risk was very low at 40 years and then increased exponentially with age (table 2, figure 2). COPD lifetime risk was higher in
Discussion
We have shown that the lifetime risk of physician-diagnosed COPD in a large, multicultural, North American population is 27·6%, which means that about one in four people older than 35 years are likely to be diagnosed with COPD during their lifetime. Furthermore, more people were likely to be diagnosed with COPD than with congestive heart failure, acute myocardial infarction, and various common cancers. When we repeated our analysis using a highly specific (but less sensitive) health
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