Large underreporting of COPD as cause of death-results from a population-based cohort study. (September 2021)

• Record Type: Journal Article
• Authors: Lindberg, Anne; Lindberg, Lina; Sawalha, Sami; Nilsson, Ulf; Stridsman, Caroline; Lundbäck, Bo; Backman, Helena
• Is Part Of: Respiratory medicine. Volume 186(2021)
• Publication Date: 2021-09
• Subjects: Epidemiology -- Chronic obstructive pulmonary disease -- Mortality -- Risk factor -- Physician diagnosis; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2021.106518
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: In 2019, WHO estimated COPD to be the third leading cause of death in the world. However, COPD is probably underestimated as cause of death due to the well-known under-diagnosis. Aim: To evaluate the proportion of and factors associated with COPD recorded as cause of death in a long-term follow-up of a population-based COPD cohort. Methods: The study population includes all individuals (n = 551) with COPD defined as chronic airway obstruction (post-bronchodilator FEV1 /FVC<0.70) + respiratory symptoms identified after re-examinations of four population-based cohorts. Mortality and underlying or contributing cause of death following ICD-10 classification were collected from the Swedish National Board of Health and Welfares register from date of examination in 2002–04 until 2016. Results: The study sample consisted of 32.3% GOLD 1, 55.9% GOLD 2, and 11.8% GOLD 3–4. The mean follow-up time was 10.3 (SD3.77) years and the cumulative mortality 45.0%. COPD (ICD-10 J43-J44) was recorded on 28.2% (n = 70) of the death certificates (11.1%, 25.7% and 57.1% by GOLD stage), whereof n = 35 had COPD recorded as underlying and n = 35 as contributing cause of death. To have COPD recorded as cause of death was independently associated with ex- and current smoking and a self-reported physician diagnosis of COPD, while male sex, overweight/obesity and higher FEV1 % of predicted associated with the absence. Conclusions: COPD was largely underreported cause of death. Even among those with severe/very severe disease, COPD was only mentioned on 57.1% of the death certificates. Highlights: Only 28.2% had COPD recorded as either underlying or contributing cause of death. In those having COPD recorded as cause of death, it was the underlying cause in 50%. Severe COPD was not reported even as contributing cause of death in 43%. Under-diagnosis and -recognition of COPD contribute to the underreporting.