Mortality trends in women and men with COPD in Ontario, Canada, 1996–2012

Importance COPD is the third leading cause of death worldwide. Mortality trends offer an indication of how well a society is doing in fighting a disease. Objective To examine trends in all-cause, lung cancer, cardiovascular and COPD mortalities in people with COPD, overall and in men and women. Design, setting, participants Population, cohort study using health administrative data from Ontario, Canada, 1996 to 2011. Exposure A previously validated COPD case definition was used to identify all people with COPD. Main outcomes and measures All-cause, lung cancer, cardiovascular and COPD mortality rates were determined annually from 1996 to 2011 overall, and in men and women. All-cause trends were compared with all-cause trends in the non-COPD population. All rates were standardised to the 2006 Ontario population. Results The prevalence of COPD was 11.0% in 2011. Over the study period, all-cause mortality decreased significantly more in men with COPD than the non-COPD population. The same was not observed in women. COPD-specific and lung cancer mortalities, which started higher in men with COPD, decreased faster in them than in women with COPD with the two rates becoming more similar over time. Cardiovascular disease mortality declined at a relatively equal rate in both sexes. Conclusions and relevance Mortality in people with COPD has decreased; however, the decrease has been greater in men than in women. Public health interventions and medical care appear to be improving mortality in individuals with COPD but more research is needed to determine if they are benefiting both sexes equally.