Prevalence, Incidence, and Lifetime Risk for the Development of COPD in the Elderly: The Rotterdam Study

doi:10.1378/chest.08-0684

Chest

Volume 135, Issue 2, February 2009, Pages 368-377

https://doi.org/10.1378/chest.08-0684 Get rights and content

Background

COPD is a major cause of chronic morbidity and mortality throughout the world. Although the prevalence of COPD is already well documented, there are only few studies regarding the incidence of COPD.

Methods

In a prospective population-based cohort study among subjects aged ≥ 55 years, COPD was diagnosed with an algorithm based on the validation of hospital discharge letters, files from the general practitioner, and spirometry reports.

Results

In this study cohort of 7,983 participants, 648 cases were identified with incident COPD after a median follow-up time of 11 years (interquartile range, 7.8 years). This resulted in an overall incidence rate (IR) of 9.2/1,000 person-years (PY) [95% confidence interval (CI), 8.5 to 10.0]. The IR of COPD was higher among men (14.4/1,000 PY; 95% CI, 13.0 to 16.0) than among women (6.2/1,000 PY; 95% CI, 5.5 to 7.0), and higher in smokers than in never-smokers (12.8/1,000 PY; 95% CI, 11.7 to 13.9 and 3.9/1,000 PY; 95% CI, 3.2 to 4.7, respectively). Remarkable was the high incidence in the youngest female age category of 55 to 59 years (7.4/1,000 PY; 95% CI, 4.1 to 12.6). For a 55-year-old man and woman still free of COPD at cohort entry, the risk for the development of COPD over the coming 40 years was 24% and 16%, respectively.

Conclusion

The overall incidence of COPD in an elderly population is 9.2/1,000 PY, with a remarkably high incidence in the youngest women, suggesting a further shift toward the female sex in the gender distribution of COPD. During their further lives, one of four men and one of six women free of COPD at the age of 55 years will have COPD develop.

Section snippets

Study Population and Baseline Data Collection

The present study is part of the Rotterdam Study, an ongoing population-based cohort study aimed at assessing the occurrence of and risk factors for chronic diseases in the elderly. Objectives and methods of the Rotterdam Study have been described elsewhere.18, 19 In short, the Rotterdam Study cohort includes 7,983 participants (78% of the eligible population) aged ≥ 55 years living in Ommoord, a well-defined suburb of the city of Rotterdam, the Netherlands. Almost all (99.8%) are of white

Baseline Characteristics

Overall, 928 well-defined COPD cases were identified in the Rotterdam Study (536 men and 392 women). A total of 280 patients had prevalent COPD at baseline. In the remaining study population (n = 7,703), COPD developed in 648 participants (8.4%), of whom 376 were classified as definite, and 272 as probable cases (Fig 1). The median follow-up time was 11 years (interquartile range, 7.8 years), and there were 70,209 years of observation; 3,669 participants (46%) were deceased, and 371

Discussion

In this large ongoing prospective cohort study of elderly people, the overall incidence rate of COPD was 9.2/1,000 PY. The incidence increased with age and was higher in men than in women, as well as higher in smokers than in never-smokers. This is the first study calculating the age- and sex-adjusted lifetime risk for the development of COPD, corrected for the competing risk of dying. For a 55-year-old individual without COPD, the risk for the disease over the coming 40 years was 24% for men

Acknowledgment

The authors thank Mrs. Jolande Verkroost for preparing the data set for the validation of the COPD cases. We also thank Prof. Dr. Jan Heeringa, the research assistants, and all our other colleagues in the Ommoord Research Center for their efforts in the data collection.

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The Rotterdam Study is supported by Erasmus Medical Center Rotterdam; the Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development; the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; and the Ministry of Health, Welfare and Sports. This study was supported by the Netherlands Organization for Scientific Research grants 904-61-093 and 918-46-615. Dr. van Durme received a travel grant by the Belgian Thoracic Society and is a doctoral research fellow of the Fund for Scientific Research Flanders (Vlaanderen).

The authors have no conflicts of interest to disclose.

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Chest

Original ResearchCOPDPrevalence, Incidence, and Lifetime Risk for the Development of COPD in the Elderly: The Rotterdam Study

Background

Methods

Results

Conclusion

Section snippets

Study Population and Baseline Data Collection

Baseline Characteristics

Discussion

Acknowledgment

Lancet

Chest

Chest

Comput Methods Programs Biomed

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease

Update in chronic obstructive pulmonary disease 2006

Am J Respir Crit Care Med

Epidemiology and costs of chronic obstructive pulmonary disease

Eur Respir J

Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994

Arch Intern Med

The burden of asthma and chronic obstructive pulmonary disease: data from the Netherlands

Pharmacoeconomics

Epidemiology of chronic obstructive pulmonary disease

Eur Respir J

The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design

COPD

Estimating the burden of disease attributable to smoking in South Africa in 2000

S Afr Med J

Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey

Am J Respir Crit Care Med

A 10-year follow-up study of respiratory symptoms and ventilatory function in a middle-aged rural-population

Eur J Respir Dis

Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study: risk of chronic obstructive pulmonary disease

Am Rev Respir Dis

Original Research
COPD
Prevalence, Incidence, and Lifetime Risk for the Development of COPD in the Elderly: The Rotterdam Study