Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
Krefting Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Respir Med. 2021 Sep;186:106518. doi: 10.1016/j.rmed.2021.106518. Epub 2021 Jun 24.
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.
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.
The study population includes all individuals (n = 551) with COPD defined as chronic airway obstruction (post-bronchodilator FEV/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.
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 FEV% of predicted associated with the absence.
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.
2019 年，世界卫生组织（WHO）估计 COPD 是全球第三大死亡原因。然而，由于众所周知的诊断不足，COPD 可能被低估为死亡原因。
评估在一项基于人群的 COPD 队列的长期随访中，将 COPD 记录为死因的比例和相关因素。
研究人群包括所有（n=551）经支气管扩张剂后 FEV/FVC<0.70 定义为慢性气道阻塞（COPD）+经四次人群队列复查后出现呼吸道症状的个体。死亡率和根据 ICD-10 分类的根本死因或促成死因，从瑞典国家卫生和福利委员会登记处从 2002-04 年的检查日期开始收集到 2016 年。
研究样本由 32.3%的 GOLD 1 期、55.9%的 GOLD 2 期和 11.8%的 GOLD 3-4 期组成。平均随访时间为 10.3（SD3.77）年，累积死亡率为 45.0%。在 28.2%（n=70）的死亡证明上记录了 COPD（ICD-10 J43-J44）（GOLD 分期分别为 11.1%、25.7%和 57.1%），其中 n=35 例 COPD 被记录为根本死因，n=35 例 COPD 被记录为促成死因。将 COPD 记录为死因与既往和当前吸烟以及自我报告的 COPD 医生诊断独立相关，而男性、超重/肥胖和更高的 FEV%预测值与 COPD 不存在相关。
COPD 是死因的主要漏报原因。即使在那些患有严重/非常严重疾病的患者中，也只有 57.1%的死亡证明提到了 COPD。
