Chest
Volume 141, Issue 1, January 2012, Pages 101-110
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Original Research
COPD
Changes in Mortality Among US Adults With COPD in Two National Cohorts Recruited From 1971-1975 and 1988-1994

https://doi.org/10.1378/chest.11-0472Get rights and content

Background

COPD is a major contributor to the global burden of disease. Our objective was to examine changes in the mortality rate among persons with COPD in the United States.

Methods

We conducted prospective studies using data from 5,185 participants in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (baseline examination from 1971-1975; follow-up from 1992-1993) and 10,954 participants of the NHANES III Linked Mortality Study (baseline examination from 1988-1994; follow-up through 2006).

Results

The age-adjusted rate (per 1,000 person-years) among participants with moderate or severe COPD (23.9 and 20.2) was about 2.5 to 3 times higher than the rate among participants with normal lung function (10.4 and 6.2) in NHANES I and NHANES III, respectively. Compared with NHANES I, the mortality rate among participants in NHANES III decreased by 15.8% for those with moderate or severe COPD, 25.2% for those with mild COPD, 35.9% for those with respiratory symptoms with normal lung function, 16.6% for those with restrictive impairment, and 40.1% for those with normal lung function. However, the decrease did not reach statistical significance among participants with moderate or severe COPD. The decreases in the mortality rate among men with moderate or severe COPD (−17.8%) or with restrictive impairment (−35.1%) exceeded the changes among women (+3% and −6.1%, respectively).

Conclusions

The secular decline in the mortality rate in the United States benefited people with COPD less than those with normal lung function.

Section snippets

Materials and Methods

We used data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (baseline examination from 1971-1975; follow-up through part of 1993) and the NHANES III Linked Mortality study (baseline examination from 1988-1994; follow-up through 2006).6, 7 Participants of the original surveys were selected by use of a stratified multistage probability sample and were deemed to be representative of the civilian noninstitutionalized population in the United

Results

Of the 6,902 NHANES I participants aged 25 to 74 years who attended the mobile examination center, 5,533 were assigned a GOLD classification. Exclusions of missing values of study variables and loss to follow-up reduced the sample to 5,185 participants. Of the 12,831 eligible NHANES III participants aged 25 to 74 years who attended the mobile examination center, 12,016 were assigned a GOLD classification. After exclusions of missing values of other study variables, 10,954 NHANES III

Discussion

The present analyses of two nationally representative cohorts of adults in the United States indicate that among adults with either COPD or with restrictive impairment, the age-adjusted mortality rate improved but not always significantly. However, adults with moderate or severe COPD or with restrictive impairment failed to experience a reduction in mortality similar to that experienced by adults with mild COPD, respiratory symptoms alone, or normal lung function. Furthermore, men with moderate

Conclusions

The present analyses suggest that the relative change in the all-cause mortality rate among adults with moderate to severe COPD was smaller than that among adults with normal lung function. Consequently, the mortality gap between these groups of adults failed to shrink. Of note was the stagnating all-cause mortality rate among women with moderate to severe COPD. If our results are confirmed, the reasons for the suboptimal change in the mortality rate among patients with COPD will require

Acknowledgments

Author contributions: Dr Ford had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Ford: contributed to the study concept and design, acquisition of data, analysis and interpretation of data, statistical analysis, study supervision, drafting of the manuscript, and critical revisions of the manuscript for important intellectual content.

Dr Mannino: contributed to the study concept and design, acquisition of

References (31)

  • American Lung Association

    State of lung disease in diverse communities 2010. American Lung Association Web site

  • National Heart, Lung, and Blood Institute

    Morbidity & mortality: 2009 chartbook on cardiovascular, lung, and blood diseases. National Heart, Lung, and Blood Institute Web site

  • DM Mannino et al.

    Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study

    Thorax

    (2003)
  • Centers for Disease Control and Prevention

    NHEFS linked mortality file. Centers for Disease Control and Prevention Web site

  • Centers for Disease Control and Prevention

    NHANES III linked mortality file. Centers for Disease Control and Prevention Web site

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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