Elsevier

The Lancet

Volume 378, Issue 9795, 10–16 September 2011, Pages 991-996
The Lancet

Articles
Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study

https://doi.org/10.1016/S0140-6736(11)60990-2Get rights and content

Summary

Background

Although chronic obstructive pulmonary disease (COPD) is one of the most deadly, prevalent, and costly chronic diseases, no comprehensive estimates of the risk of developing COPD in the general population have been published. We aimed to quantify the lifetime risk of developing physician-diagnosed COPD in a large, multicultural North American population.

Methods

We did a retrospective longitudinal cohort study using population-based health administrative data from Ontario, Canada (total population roughly 13 million). All individuals free of COPD in 1996 were monitored for up to 14 years for three possible outcomes; diagnosis of COPD by a physician, reached 80 years of age, or death. COPD was identified with a previously validated case definition based on COPD health services claims. The cumulative incidence of physician-diagnosed COPD over a lifetime adjusted for the competing risk of death was calculated by a modified survival analysis technique. Results were stratified by sex, socioeconomic status, and whether individuals lived in a rural or urban setting.

Findings

A total of 579 466 individuals were diagnosed with COPD by a physician over the study period. The overall lifetime risk of physician-diagnosed COPD at age 80 years was 27·6%. Lifetime risk was higher in men than in women (29·7% vs 25·6%), individuals of lower socioeconomic status than in those of higher socioeconomic status (32·1% vs 23·0%), and individuals who lived in a rural setting than in those who lived in an urban setting (32·4% vs 26·7%).

Interpretation

About one in four individuals are likely to be diagnosed and receive medical attention for COPD during their lifetime. Clinical evidence-based approaches, public health action, and more research are needed to identify effective strategies to prevent COPD and ensure that those with the disease have the highest quality of life possible.

Funding

Government of Ontario, Canada.

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.

Section snippets

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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