Management, morbidity and mortality of COPD during an 11-year period: an observational retrospective epidemiological register study in Sweden (PATHOS)

Björn Ställberg, Christer Janson, Gunnar Johansson, Kjell Larsson, Georgios Stratelis, Gunilla Telg, Karin H Lisspers, Björn Ställberg, Christer Janson, Gunnar Johansson, Kjell Larsson, Georgios Stratelis, Gunilla Telg, Karin H Lisspers

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality and a major contributor to morbidity. Longitudinal clinical practice data yielding information on the characteristics of the disease, its natural course, and management are limited.

Aims: To investigate and describe the COPD population from a nationwide perspective during an 11-year period (1999-2009) with a focus on management, co-morbidity, and mortality.

Methods: This observational retrospective epidemiological study linked electronic medical records data from patients with COPD in primary care to mandatory Swedish hospital, drug and Cause of Death registry data from 1999 to 2009 (PATHOS).

Results: A total of 21,361 patients with a COPD diagnosis were included (mean age 68.0 years, 53% females). The proportion of patients diagnosed in primary care increased from 59% in 1999 to 81% in 2009 and the mean age at diagnosis decreased from 73 to 66 years. The number of exacerbations decreased from 3.0 to 1.3 and COPD-related hospitalisations decreased from 1.02 to 0.20 per patient per year. Prescriptions of long-acting muscarinic antagonists and fixed combinations of inhaled corticosteroid/long-acting β2-agonist inhalers increased from 0% to 36% and 37%, respectively. The most common co-morbidities were hypertension, heart failure, ischaemic heart disease, and diabetes. Overall life expectancy was 8.3±6.8 years shorter in patients with COPD than in the general population, and all- cause mortality was 3.5 times higher.

Conclusions: Management of COPD in Sweden has improved during the 11-year study period. Despite this, patients with COPD have a substantially reduced life expectancy than the general population.

Conflict of interest statement

BS has received honoraria for educational activities from AstraZeneca, GlaxoSmithKline, Meda, Merck Sharp and Dohme, and has served on an advisory board arranged by AstraZeneca, Novartis, and Boehringer Ingelheim. He is an Associate editor of the PCRJ, but was not involved in the editorial review of, nor the decision to publish, this article. CJ has received honoraria for educational activities from AstraZeneca, GlaxoSmithKline, and Merck Sharp and Dohme. GJ has served on an advisory board arranged by AstraZeneca and Takeda. KL has served on an advisory board and/or served as a speaker and/or participated in education arranged by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Meda, MSD, Nycomed, Novartis, and Pfizer. KL has also received unrestricted research grants from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. GS and GT are full-time employees of AstraZeneca Nordic. KHL has received speaking fees from AstraZeneca, Boehringer Ingelheim, and Merck Sharp and Dohme.

Figures

Figure 1. Incidence and prevalence of chronic…
Figure 1. Incidence and prevalence of chronic obstructive pulmonary disease in patients >40 years of age, and death rate at index date per 1000 inhabitants, split by gender, in primary care during the 11-year study (1999–2009)
Figure 2. Prescriptions of chronic obstructive pulmonary…
Figure 2. Prescriptions of chronic obstructive pulmonary disease (COPD)-related medications in primary care during the 11-year study period (1999–2009), expressed as percentage of patients per year
Figure 3. Chronic obstructive pulmonary disease (COPD)-related…
Figure 3. Chronic obstructive pulmonary disease (COPD)-related events (mean yearly rate) during the 11-year study period (1999–2009)

References

    1. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, 2007. Available from:
    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2011. Available from:
    1. Soriano JB, Visick GT, Muellerova H, Payvandi N, Hansell AL. Patterns of comorbidity in newly diagnosed COPD and asthma in primary care. Chest 2005;128(4):2099–107.
    1. Gudmundsson G, Gislason T, Janson C, et al. Depression, anxiety and health-related quality of life at discharge after hospitalisation for exacerbation of COPD: a multicenter study in the Nordic countries. Respir Med 2006;100(1):87–93.
    1. van der Molen T. Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences. Prim Care Respir J 2010;19(4):326–34.
    1. Sundh J, Ställberg B, Lisspers K, Montgomery S, Janson C. Comorbidity, body mass index and quality of life in COPD using the Clinical COPD Questionnaire. J COPD 2011;8(3):173–81.
    1. Toy EL, Gallagher KF, Stanley EL, Swensen AR, Duh MS. The economic impact of exacerbations of chronic obstructive pulmonary disease and exacerbation definition: a review. J COPD 2010;7(3):214–28.
    1. Chu CM, Chan VL, Lin AW, Wong IW, Leung WS, Lai CK. Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure. Thorax 2004;59(12):1020–5.
    1. Gudmundsson G, Gislason T, Janson C, et al. Risk factors for rehospitalisation in COPD: the role of health status, anxiety and depression. A multicenter study in the Nordic countries. Eur Respir J 2005;26(3):414–19.
    1. Gudmundsson G, Ulrik CS, Gislason T, et al. Long-term survival in patients hospitalized for chronic obstructive pulmonary disease: a prospective observational study in the Nordic countries. Int J COPD 2012;7:571–6. .
    1. Lindberg A, Bjerg A, Rönmark E, Larsson LG, Lundbäck B. Prevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking. Report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med 2006;100(2):264–72.
    1. Bednarek M, Maciejewski J, Wozniak M, Kuca P, Zielinski J. Prevalence, severity and underdiagnosis of COPD in the primary care setting. Thorax 2008;63(5):402–07.
    1. Sundblad BM, Larsson K, Nathell L. Low awareness of COPD among physicians. Clin Respir J 2008;2(1):11–16.
    1. Gershon A, Croxford R, To T, et al. Trends in chronic obstructive pulmonary disease prevalence, incidence, and mortality in Ontario, Canada, 1996 to 2007: a population-based study. Arch Intern Med 2010;170(6):560–5.
    1. Danielsson P, Ólafsdóttir IS, Benediktsdóttir B, Gíslason T, Janson C. The prevalence of COPD in Uppsala, Sweden — The Burden of Obstructive Lung Disease (BOLD) study: cross-sectional population-based study. Clin Respir J 2012;6(2):120–7.
    1. National Board of Health and Welfare. Socialstyrelsens riktlinjer för vård av astma och kroniskt obstruktiv lungsjukdom (KOL). Faktadokument och beslutsstöd för prioriteringar. 2004. Available from:
    1. Larsson K, Janson C, Lisspers K, et al. Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study. J Intern Med 2013;273(6):584–94.
    1. Martinell M, Stålhammar J, Hallqvist J. Automated data extraction — a feasible way to construct patient registers of primary care utilization. Ups J Med Sci 2012;117(1):52–6.
    1. Gingter C, Wilm S, Abholz HH. Is COPD a rare disease? Prevalence and identification rates in smokers aged 40 years and over within general practice in Germany. Fam Pract 2009;26(1):3–9.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–83.
    1. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43(11):1130–9.
    1. Atsou K, Chouaid C, Hejblum G. Variability of the chronic obstructive pulmonary disease key epidemiological data in Europe: systematic review. BMC Med 2011;9:7.
    1. Lisspers K, Ställberg B, Hasselgren M, Johansson G, Svärdsudd K. Organisation of asthma care in primary health care in mid-Sweden. Prim Care Respir J 2005;14(3):147–53.
    1. Thorn J, Norrhall M, Larsson R, et al. Management of chronic obstructive pulmonary disease (COPD) in primary care: a questionnaire survey in western Sweden. Prim Care Respir J 2008;17(1):26–31.
    1. Löfdahl CG, Tilling B, Ekström T, Jörgensen L, Johansson G, Larsson K. COPD health care in Sweden — a study in primary and secondary care. Respir Med 2010;104(3):404–11.
    1. Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32(4):962–9.
    1. Curkendall SM, Lanes S, de Luise C, et al. Chronic obstructive pulmonary disease severity and cardiovascular outcomes. Eur J Epidemiol 2006;21(11):803–13.
    1. Sidney S, Sorel M, Quesenberry CP Jr, DeLuise C, Lanes S, Eisner MD. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest 2005;128(4):2068–75.
    1. Rycroft CE, Heyes A, Lanza L, Becker K. Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J COPD 2012;7:457–94.
    1. Sundh J, Janson C, Lisspers K, Montgomery S, Ställberg B. Clinical COPD Questionnaire score (CCQ) and mortality. Int J COPD 2012;7:833–42.
    1. Pinnock H, Thomas M, Tsiligianni I, et al. The International Primary Care Respiratory Group's (IPCRG) Research Needs Statement 2010. Prim Care Respir J 2010;19(Suppl 1):S1–20.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe