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a Department of
Worldwide Epidemiology, GlaxoWellcome Research and Development,
Middlesex, UK, b Department of Medical Data
Sciences, c Department of
Respiratory Clinical Development, d Respiratory
and Environmental Health Research Unit, IMIM, Barcelona, Spain, e National Heart and Lung
Institute, Imperial College School of Medicine, London, UK
Correspondence to: Dr J B Soriano, Department of Worldwide Epidemiology, GlaxoWellcome R&D, Greenford, Middlesex UB6 0HE, UK email: jbs42397{at}glaxowellcome.co.uk
Received 28 October 1999; Returned to authors 10 February 2000; Revised version received 19 April 2000; Accepted for publication 2 June 2000
BACKGROUND
Recent
trends in physician diagnosed chronic obstructive pulmonary disease
(COPD) in the UK were estimated, with a particular focus on women.
METHODSA
retrospective cohort of British patients with COPD was constructed from
the General Practice Research Database (GPRD), a large automated
database of UK general practice data. Prevalence and all-cause
mortality rates by sex, calendar year, and severity of COPD, based on
treatment only, were estimated from January 1990 to December 1997.
RESULTSA total of
50 714 incident COPD patients were studied, 23 277 (45.9%) of whom
were women. From 1990 to 1997 the annual prevalence rates of physician
diagnosed COPD in women rose continuously from 0.80% (95% CI 0.75 to
0.83) to 1.36% (95% CI 1.34 to 1.39), (p for trend <0.01), rising to
the rate observed in men in 1990. Increases in the prevalence of COPD
were observed in women of all ages; in contrast, a plateau was observed
in the prevalence of COPD in men from the mid 1990s. All-cause
mortality rates were higher in men than in women (106.8 versus 82.2 per
1000 person-years), with a consistently increased relative risk in men
of 1.3 even after controlling for the severity of COPD. Significantly
increased mortality rates were also observed in adults aged less than
65 years. The mean age at death was 76.5 years; patients with severe COPD died an average of three years before those with mild disease (p<0.01) and four years before the age and sex matched reference population.
CONCLUSIONSWhile
prevalence rates of COPD in the UK seem to have peaked in men, they are
continuing to rise in women. This trend, together with the ageing of
the population and the long term cumulative effect of pack-years of
smoking in women, is likely to increase the present burden of COPD in
the UK.
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