Department of Medicine and.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Ann Am Thorac Soc. 2021 Jul;18(7):1138-1146. doi: 10.1513/AnnalsATS.202007-822OC.
Chronic respiratory diseases, among which chronic obstructive pulmonary disease (COPD) remains the largest contributor, are the fourth leading cause of death in the United States. Updated mortality trends provide insight for targeted interventions. To provide detailed insights into COPD mortality trends. This study used death certificate data collected from the U.S. Centers for Disease Control WONDER (Wide-Ranging Online Data for Epidemiology Research) system between 2004 and 2018 among Americans 40 years of age and older. We used Joinpoint regression analysis to capture trends in annual age-adjusted COPD mortality rates and of the number of deaths caused by influenza or pneumococcal disease with COPD. To place mortality trends into perspective, we examined influenza and pneumococcal vaccination rates within the same time frame using population survey data. Overall, mortality from COPD decreased, with an annual percentage change (APC) of -0.6% (95% confidence interval [CI], -0.9% to -0.3%) between 2004, at 72.9 deaths per population of 100,000, and 2018, at 67.4 deaths per population of 100,000. COPD mortality in men exceeded that in women; however, mortality in men continued to decline, with an APC of -1.2% (95% CI, -1.5% to -0.9%), unlike mortality in women, whose death rates were overall unchanged. Further stratifying sex by race, we found that African American women were the only sociodemographic group to have had an increase in COPD mortality, with an APC of 1.3% (95% CI, 0.9% to 1.6%). The number of deaths caused by influenza with COPD had increased over time, with an observed APC of 19.58% (95% CI, 6.9% to 33.8%) between 2004 and 2018. Increased influenza mortality paralleled trends of decreased influenza vaccination rates, wherein between 2011 and 2018, there was an APC of -5.1% (95% CI, -8.2% to -2.0%). This trend was also present for those with COPD; 451.4 per 1,000 respondents in 2011 were vaccinated against influenza compared with 352.1 per 1,000 respondents in 2018, resulting in an APC of -1.8% (95% CI, -3.3% to -0.2%). Pneumococcal vaccination rates between 2011 and 2018 remained unchanged; meanwhile, deaths caused by pneumococcal disease with COPD decreased, with an APC of -10.1% (95% CI, -16.6% to -3.1%). COPD mortality has decreased among Americans overall; however, there remain important sociodemographic groups that have not secured the same deceleration in death rates.
慢性呼吸道疾病，其中慢性阻塞性肺疾病（COPD）仍然是最大的致病因素，是美国第四大死亡原因。更新的死亡率趋势为有针对性的干预措施提供了见解。为了详细了解 COPD 死亡率趋势，本研究使用了美国疾病控制与预防中心 WONDER（广泛在线流行病学研究数据）系统收集的 2004 年至 2018 年间美国 40 岁及以上人群的死亡证明数据。我们使用 Joinpoint 回归分析来捕捉 COPD 死亡率的年度年龄调整趋势，以及流感或肺炎球菌疾病引起的 COPD 死亡人数的趋势。为了将死亡率趋势放在适当的背景下，我们在同一时间框架内使用人群调查数据检查了流感和肺炎球菌疫苗接种率。总的来说，COPD 死亡率下降，2004 年为每 10 万人中有 72.9 人死亡，2018 年为每 10 万人中有 67.4 人死亡，年百分比变化（APC）为-0.6%（95%置信区间[CI]：-0.9%至-0.3%）。男性 COPD 死亡率高于女性；然而，男性的死亡率继续下降，APC 为-1.2%（95%CI：-1.5%至-0.9%），而女性的死亡率则保持不变。进一步按性别和种族分层，我们发现，非裔美国女性是唯一 COPD 死亡率上升的社会人口群体，APC 为 1.3%（95%CI：0.9%至 1.6%）。与 COPD 相关的流感死亡人数随着时间的推移而增加，2004 年至 2018 年期间观察到的 APC 为 19.58%（95%CI：6.9%至 33.8%）。流感死亡率的增加与流感疫苗接种率的下降趋势相吻合，2011 年至 2018 年间，APC 为-5.1%（95%CI：-8.2%至-2.0%）。对于 COPD 患者也是如此；2011 年每 1000 名受访者中有 451.4 人接种了流感疫苗，而 2018 年每 1000 名受访者中有 352.1 人接种了流感疫苗，APC 为-1.8%（95%CI：-3.3%至-0.2%）。2011 年至 2018 年期间，肺炎球菌疫苗接种率保持不变；与此同时，与 COPD 相关的肺炎球菌疾病引起的死亡人数减少，APC 为-10.1%（95%CI：-16.6%至-3.1%）。总的来说，美国人的 COPD 死亡率有所下降；然而，仍有一些重要的社会人口群体没有降低死亡率。
