Articles
Mortality trends in chronic obstructive pulmonary disease in Europe, 1994–2010: a joinpoint regression analysis

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Summary

Background

Findings from studies done over the past 20 years suggest that mortality from chronic obstructive pulmonary disease (COPD) is decreasing worldwide, but little information is available for trends in Europe. We aimed to describe COPD mortality trends by sex and calendar year for the period of 1994 to 2010.

Methods

We extracted data for COPD deaths between 1994 and 2010 in the 27 countries in the European Union (EU) from the statistical office of the EU (Eurostat), using the International Classification of Diseases 10 (ICD-10) codes J40–J44 and J47. We estimated age-standardised mortality rates (ASR), and analysed data using joinpoint regression, for women and men in the EU overall and by individual country for each year. We used the standard European population as the reference and present our findings as deaths per 100 000 person-years. We compared findings for each country with the EU average by calculating standardised rate ratios (SRR) and 95% CIs.

Findings

Between 1994 and 2010, there were 2 348 184 recorded COPD deaths in the EU. COPD mortality was higher in men than in women throughout the study period in all EU countries. In the EU overall, deaths per 100 000 population decreased in men almost linearly from 90·07 in 1994 to 61·33 in 2010, and in women from 26·99 in 1994 to 25·15 in 2010, representing a narrowing in gender gap over the study period. Several countries had a higher SRR mortality than the EU average—eg, Ireland, Hungary, and Belgium for men and Denmark, the UK, and the Netherlands for women. Our joinpoint regression analysis identified no statistically significant changes in the trend for the whole EU, but several countries had changing trends over the study period. In men, we recorded a 2·56% constant and statistically significant decrease in ASRs in the EU. Five countries had an increase in ASR. Overall, in women, we recorded a 0·76% statistically significant decrease in ASRs. 14 countries had an increase in ASR.

Interpretation

Our findings indicate a downward trend in COPD mortality in Europe between 1994 and 2010. The data also suggest a narrowing of the gap between COPD mortality in men and in women. The wide heterogeneity in mortality rates within European countries could serve as a reference to allow informed policy making.

Funding

None.

Introduction

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that causes much morbidity, mortality, and socioeconomic burden.1 COPD mortality has been constantly increasing, with projections that it will become the fourth leading cause of death by 2030.2 However, despite concordant publications indicating an increase in the number of deaths due to COPD worldwide, in the past few years several publications have reported decreases and downward projections of COPD mortality rates in various countries, such as Japan, USA, Australia, and Spain.3, 4, 5, 6

An update of the Global Burden of Diseases, Injuries, and Risk Factors Study in 2010 estimated the annual deaths from 235 causes for 21 world regions between 1980 and 2010, by age and sex. Although COPD was the third leading cause of death in 2010, age-standardised death rates decreased by 43·3% in the past two decades, falling from 77·4 per 100 000 in 1990 to 43·8 per 100 000 in 2010.7 Worldwide, an estimated 328 million people had COPD in 2010, and COPD was the fifth major cause of years lived with disability, ranking behind back pain, major depressive disorders, iron-deficiency anaemia, and neck pain.8

Although very valuable, these global figures do not inform of trends within countries, many of which have different health-care systems and are at different phases of the smoking epidemic; great variability is, therefore, expected between countries. Furthermore, these studies do not provide estimates of when a change in disease mortality rate, if any, occurred.

We aimed to describe trends in the risk of dying from COPD in people older than 40 years in the European Union (EU) by sex and calendar year between 1994 and 2010. This estimation might help to identify high-risk areas and provide health-care policy makers with evidence for more focused health intervention in COPD, from prevention to palliative care.

Section snippets

Methods

Deaths in the 27 EU countries are those detailed by the statistical office of the EU (Eurostat; Luxemburg) where the International Classification of Diseases 10 (ICD-10) codes J40–J44 and J47 were selected from the years 1994 to 2010. The database was updated on April 8, 2013. We used the underlying cause of death for this analysis, which is defined by Eurostat as “the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or

Results

Between 1994 and 2010, there were 1 475 061 recorded COPD deaths in men and 873 123 recorded COPD deaths in women. Age-standardised COPD mortality rates in men decreased linearly (figure 1), although there was much variability between countries (table 1). The downward trend over the same period in women was less pronounced (figure 1; table 2). The male-to-female ratio in COPD mortality decreased from 3·3 in 1994 to 2·4 in 2010. If these trends in both sexes were to continue, we estimate that

Discussion

Our findings substantiate other reports of decreasing COPD mortality rates in the EU,7 but with some additional key findings. First, although men have a much higher COPD mortality rate than women in all countries, the trend, in the EU overall and by country, is a decrease in the mortality rates for both sexes, with steeper decreases for men than women, indicating a narrowing of the disparity between sexes. Second, these mortality trends differ between countries and sexes, with some countries

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