Perspectives in Disease Prevention and Health Promotion
Deaths due to Chronic Obstructive Pulmonary Disease and Allied
Conditions
In 1984, chronic obstructive pulmonary disease (COPD) and
allied
conditions were the eleventh leading cause of years of potential
life
lost before age 65 (YPLL) in the United States, accounting for
123,000
YPLL (see Table V, page 517). The category "COPD and allied
conditions" is composed of a variety of diseases, including
bronchitis, emphysema, asthma, bronchiectasis, extrinsic allergic
alveolitis, and chronic airway obstruction not specifically labeled
as
one of the preceding conditions. Chronic airway obstruction was
responsible for the most deaths and YPLL in 1983 (Table 2).
Because
the causes of death in this category are probably the same as in
the
bronchitis and emphysema category, for this report, those three
categories are combined as COPD.
From 1979 through 1983, the last year for which age-, sex-,
race-,
and cause-specific mortality data are available, both YPLL and YPLL
rates per 100,000 population for COPD did not vary appreciably
(Figure
2). Rates for males were roughly twice those for females. White
males and males of all other races had similar rates, whereas the
rate
for white females consistently exceeded the rate for females of
other
races. In contrast, YPLL rates for asthma increased between 1979
and
1983 (Figure 3). Rates for black and other males and females were
higher and increased more than the rates for whites throughout the
5-year period.
Reported by Behavioral Epidemiology and Evaluation Br, Div of
Health
Education, Center for Health Promotion and Education, CDC.
Editorial Note
Editorial Note: COPD is an important health problem for Americans,
causing an estimated 4.7 million hospital days per year and $6.5
billion in direct and indirect costs (1). Smoking accounts for
80%-90% of COPD mortality for both men and women. The total death
rate and YPLL rate are higher for men than for women and higher for
whites than for other races. These findings probably reflect
previous
differences in smoking patterns among these groups. The risk of
COPD
increases with the dose of exposure, i.e., number of cigarettes
smoked
per day, and the duration of smoking. Within a few years after
beginning to smoke, smokers have a higher prevalence of abnormal
function of the small airways than nonsmokers, and the severity of
dysfunction increases with years of smoking. Smoking cessation
leads
to a decreased risk of mortality; however, even 20 years after
cessation, the risk of death from COPD for former smokers is not as
low as for persons who have never smoked (2).
The Surgeon General's report in 1979 indicated that inhaled
tobacco smoke can trigger or aggravate asthmatic symptoms in
persons
with asthma (3). This offers support for the cessation of smoking
and
the avoidance of passive smoke exposure in asthmatic individuals.
Different mortality measures can emphasize different public
health
perspectives. COPD is primarily a disease of older persons, while
asthma is more likely to affect younger persons: in 1983, 18.9% of
asthma-related deaths occurred among persons under 45 years of age,
in
contrast to only 0.7% of COPD deaths. Total deaths and crude death
rates reflect the total impact for a specific cause of death for
all
age groups. YPLL and YPLL rates, in contrast, may emphasize deaths
among younger persons, making the contribution of asthma to
mortality
more apparent. For example, a person who dies at age 30 from
asthma
contributes 35 years to the total YPLL, whereas a person who dies
at
age 60 from COPD contributes 5 years to the total YPLL. The death
rate for persons of all ages for COPD is 18 times greater than that
for asthma, whereas the YPLL rate for COPD is 2.5 times greater.
YPLL rates for asthma appear to have increased over the 5-year
period, especially among black and other males. This suggests the
need to further examine factors such as: (1) improved diagnosis of
asthma over time; (2) an actual increase in the asthma mortality
rate
among younger persons; or (3) changes in the effectiveness of
treatment for life-threatening asthma attacks.
References
Farer LS, Schieffelbein CW. Position paper on respiratory
diseases. In: Closing the gap. Atlanta, Georgia: The Carter
Center of Emory University, Health Policy Project, November
1984.
Office on Smoking and Health. The health consequences of
smoking: chronic obstructive lung disease. A report of the
Surgeon General. Rockville, Maryland: US Department of Health
and Human Services, Public Health Service, 1984. DHHS
publication
no. (PHS) 84-50205.
Office on Smoking and Health. Smoking and health. A report of
the Surgeon General. Rockville, Maryland: US Department of
Health, Education, and Welfare, Public Health Service, 1979.
DHEW
publication no. (PHS) 79-50066.
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