Recent trends in physician diagnosed COPD in women and men in the UK

Abstract

Background-Recent trends in physician diagnosed chronic obstructive pulmonary disease (COPD) in the UK were estimated, with a particular focus on women. Methods-A retrospective cohort of British patients with COPD was constructed from the General Practice Research Database (GPRD), a large automated database of UK general practice data. Prevalence and all-cause mortality rates by sex, calendar year, and severity of COPD, based on treatment only, were estimated from January 1990 to December 1997. Results-A total of 50 714 incident COPD patients were studied, 23 277 (45.9%) of whom were women. From 1990 to 1997 the annual prevalence rates of physician diagnosed COPD in women rose continuously from 0.80% (95% CI 0.75 to 0.83) to 1.36% (95% CI 1.34 to 1.39), (p for trend <0.01), rising to the rate observed in men in 1990. Increases in the prevalence of COPD were observed in women of all ages; in contrast, a plateau was observed in the prevalence of COPD in men from the mid 1990s. Allcause mortality rates were higher in men than in women (106.8 versus 82.2 per 1000 person-years), with a consistently increased relative risk in men of 1.3 even after controlling for the severity of COPD. Significantly increased mortality rates were also observed in adults aged less than 65 years. The mean age at death was 76.5 years; patients with severe COPD died an average of three years before those with mild disease (p<0.01) and four years before the age and sex matched reference population. Conclusions-While prevalence rates of COPD in the UK seem to have peaked in men, they are continuing to rise in women. This trend, together with the ageing of the population and the long term cumulative eVect of pack-years of smoking in women, is likely to increase the present burden of COPD in the UK. (Thorax 2000;55:789-794)

Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients

“…22 Prevalence rates at the beginning of the study period in 2001 (female: 1.3%; male 1.5%) were also very similar to those found in 1997 using the UK General Practice Research Database (female 1.4%; male 1.6%). 4 Higher rates of COPD diagnosed in primary care in northern England and deprived communities found in the present study have also been previously reported. 23 Mean consultation rates (7.9 per year) were higher than those from a survey conducted in 2002 of 500 patients throughout the UK with COPD (6.6 visits per year), although this was a telephone survey that relied on patient recollection and may have been affected by recall bias.…”

“…It was hypothesised that this sex disparity resulted from the rising prevalence of smoking among women in the 1980s and 1990s and the longstanding plateau in smoking cessation among men. 4 The prevention of smoking and the promotion of smoking cessation services are the main strategies to prevent the occurrence and reduce the burden of COPD. In this vein, it is likely that the 2004 Public Service Agreement in England objectives of reducing overall adult smoking rates from 26% to 21% or less by 2010 5 are likely to be surpassed.…”

Recent trends in lung cancer and its association with COPD: an analysis using the UK GP Research Database

“…Nevertheless, both lung cancer and COPD have been previously studied in the GPRD and the findings reported. [13][14][15][16][18][19][20][21] Indeed, the higher risk of lung cancer we found among those with COPD aged 65 or older has also been reported elsewhere. 29 In a large, recent study, Wilson et al, 31 using CT scan together with spirometry to search for emphysema and lung cancer in 3,638 smokers, were intrigued to find absence of a doseresponse relationship between smoking intensity and lung cancer among those with moderate to severe emphysema -a finding which has led to the hypothesis that COPD patients may have some host or susceptibility factors that protect them from developing cancer in general (having taken 30 or more years of exposure to tobacco to develop COPD), whereas in those who are more susceptible to developing cancer, lung cancer is likely to be diagnosed before COPD.…”

“…A growing number of studies conducted in the GPRD database have been widely reported elsewhere, and the GPRD update as of December 2006 was used in this study. [18][19][20][21] This study was conducted within a research protocol approved by the Independent Scientific Advisory Committee (ISAC) of the GPRD.…”

“…As COPD is a serious condition that needs regular medical management, an individual was considered censored if no GP contact was recorded 12 months after his/her last visit or medical contact -as was done in previous studies using the database. [18][19][20][21] In a similar way, censoring was applied when a patient either left the practice or died.…”