Real-world study on causes of death in people with Chronic Obstructive Pulmonary Disease (COPD) in England

COPD is characterized by persistent respiratory symptoms and airflow obstruction. While previous studies have evaluated the mortality burden of COPD, there is limited recent research describing the leading causes of death. This study sought to describe mortality in people with COPD and identify the leading causes of death, overall and by sub-groups of interest. In this longitudinal cohort study of people with COPD in the CPRD Aurum database linked with Hospital Episode Statistics and death data from the Office for National Statistics from England (1 Jan 2014‒10 Mar 2020), mortality rates (per 1000 patient years [PYs]) are described overall, by the top five causes (based on 3-digit ICD10 codes) and for pre-specified causes. Patients were stratified by groups, including COPD severity levels. Of 369,910 people with COPD (median age 69 years, 47% women, 93% White), 24.7% died over a median of 3.7 years follow-up; 67.4 (95%CI 67.0‒67.9) deaths per 1000 PYs. Cause-specific rates per 1000 PYs were 17.4 (17.2‒17.6) for COPD-related mortality, 9.6 (9.4‒9.7) for CVD, 7.9 (7.7‒8.0) for lung cancer, 1.9 (1.9‒2.0) for pneumonia, and 1.9 (1.8‒2.0) for dementia. Men with COPD had a numerically higher rate of CVD-related mortality, and women with COPD for dementia-related mortality. People with severe COPD had a numerically higher overall mortality rate. COPD, CVD and lung cancer were the leading primary causes of death among people with COPD. These findings provide up to date information on the mortality burden of COPD, and highlight the importance of comprehensive multidisciplinary management strategies to address both respiratory and comorbid conditions for improved survival in COPD.