Chronic obstructive pulmonary disease (COPD)

Deaths

How many die from COPD?

COPD is a major leading cause of death in Australia. In 2018, 7,113 people were recorded as having died from COPD (3,783 men and 3,330 women) making it the fifth leading cause of death after coronary heart disease, dementia and Alzheimer disease, cerebrovascular disease, and lung cancer.

Notes

1. Leading causes of death are based on underlying causes of death and classified using an AIHW-modified version of Becker et al. 2006. International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes are presented in parentheses.
2. Per cent is the per cent of all causes—the proportion of deaths out of total number of deaths.
3. Year refers to year of registration of death. Deaths registered in 2018 are based on preliminary version. preliminary versions are subject to further revision by the Australian Bureau of Statistics (ABS).

Source: AIHW analysis of the AIHW National Mortality Database.

It is worth noting that COPD is more likely to be reported as an associated cause of death rather than the underlying cause of death. In 2018, there were 11,385 deaths where COPD was listed as an associated cause in addition to the 7,113 deaths where COPD was listed as the underlying cause.

The statistics presented here relate to deaths where COPD was listed as the underlying cause of death. For information on long-term trends, see General Record of Incidence of Mortality (GRIM) books. For more information on how deaths are registered, coded and updated, see Deaths data.

COPD mortality trends over time

In Australia, the COPD mortality rate among men aged 45 and over decreased dramatically by almost two thirds between 1980 and 2006, from 228 to 84 per 100,000 population, and then fluctuated between 2007 and 2013. After that, it dropped slightly from 2014 (91 per 100,000 population) to 2018 (76 per 100,000 population). Over the same period, the mortality rate for women aged 45 and over fluctuated, with the lowest at 39 per 100,000 population in 1980 and highest at 66 per 100,000 population in 1996.

The main risk factor for the development and progression of COPD is smoking, with smokers being 12 to 13 times more likely to die from COPD than non-smokers (U.S. Department of Health and Human Services 2014). The improvements in COPD mortality rates are expected to follow improvements in smoking rates, with a time-lag between smoking and COPD mortality. This is because chronic conditions, such as COPD, have a long latency period, that is, smoking early in life is involved in initiating disease processes prior to disease diagnosis (Lynch & Smith 2005). In Australia, the smoking rate of adults aged 18 and over decreased dramatically from 1980 to 2016 (men: 41% to 16%; women: 30% to 12%) (Scollo & Winstanley 2019).

As shown in Figure 1, smoking rates in Australia have decreased from 1980 onwards among both among men and women, with men having consistently higher smoking rates than women (Scollo & Winstanley 2012). For more information on the history of smoking and COPD, see Mortality from asthma and COPD in Australia, which presents detailed analysis of COPD mortality for the period 1965 to 2010.

Figure 1: Smoking rate (per cent) of people aged 18 and over and age‑standardised death rate (per 100,000 population) due to COPD, people aged 45 and over, by sex, 1980–2016

Notes

1. COPD death rates are shown as a 3-year moving average. These rates have been age-standardised to the 2001 Australian Standard Population as at 30 June 2001. Age groups: 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85+.
2. From 1979 to 1996, COPD classified according to ICD-9 codes 490, 491, 492, 496; from 1997 to 2017, COPD classified according to ICD-10 codes J40–J44. COPD occurs mostly in people aged 45 years and over. While it is occasionally reported in younger age groups, in those aged 45 years and over there is more certainty that the condition is COPD and not another respiratory condition. For this reason only people aged 45 years and over are included in this graph.
3. Smoking refers to people those reporting that they smoke 'daily' or 'at least weekly', and smoking any combination of cigarettes, pipes or cigars.
4. Smoking data were calculated by the Cancer Council of Victoria. Smoking rates for 1980–1992 were sourced from surveys conducted by the Anti-Cancer Council of Victoria; smoking rates for 1995–2016 were sourced from the National Drug Strategy Household Survey. Blank cells mean that data was not available.
5. Year refers to year of registration of death. Deaths registered in 2015 and earlier are based on the final version of cause of death data; deaths registered in 2016 are based on revised version; and deaths registered in 2017 and 2018 are based on preliminary version. Revised and preliminary versions are subject to further revision by the Australian Bureau of Statistics (ABS).

Sources: AIHW analysis of AIHW National Mortality Database, Scollo & Winstanley 2019 (Data table).

Higher death rate from COPD in certain population groups

COPD mortality rates are higher for people living in remote areas and for people living in lower socioeconomic areas (AIHW: Poulos et al. 2014). In 2018, the COPD mortality rate for those aged 45 and over living in Remote and very remote areas (103 deaths per 100,000 population) was 1.9 times as high as the rate for those living in Major cities (54 deaths per 100,000 population). Meanwhile, the COPD mortality rate for this same age group in the lowest socioeconomic areas (102 deaths per 100,000 population) was 2.8 times as high as the rate in the highest areas (36 deaths per 100,000 population).

COPD mortality rates are also higher for Indigenous Australians. In the 5-year period from 2014 to 2018, 835 Aboriginal and Torres Strait Islander people aged 45 and over died from COPD, with a mortality rate of 114 per 100,000 population, based on the five jurisdictions with adequate Indigenous identification (NSW, Qld, WA, SA and NT). After adjusting for differences in age structure, for people aged 45 and over, the mortality rate of COPD among Indigenous Australians (189 per 100,000 population) was 2.7 times as high as the non-Indigenous Australians rate (70 per 100,000 population).

The differences between these population subgroups may be due to differences in smoking rates, access to health services, or other factors. Smoking rates are higher among people living in more remote areas, among people living in areas of lower socioeconomic area, and among Indigenous Australians (AIHW 2018).

For more information about COPD mortality rates among Indigenous Australians, see Coronary heart disease and chronic obstructive pulmonary disease in Indigenous Australians.

Burden of disease

Burden of disease measures the gap between the ideal of living to old age in good health, and the current situation where healthy life is shortened or lost by illness, injury, disability and death (AIHW 2019a). It combines health loss from living with illness and injury (non-fatal burden, or years lived with disability [YLD]) and dying prematurely (fatal burden, or years of life lost [YLL]) to estimate total health loss (total burden, or disability-adjusted life years [DALY]). One DALY is one year of 'healthy life' lost due to illness and/or death.

What is the burden of disease due to COPD?

In Australia, COPD accounted for over half (51%) of the total burden of disease due to respiratory conditions and 3.9% of the total disease burden in 2015 (AIHW 2019a). Between 2003 and 2015, there was a 6.0% decrease in the total disease burden due to COPD.

Overall, COPD was the third leading specific cause of total disease burden. COPD is the leading cause of total burden in women aged 65–74 (22.6 DALYs per 1,000 population), and the second leading cause of total burden in men aged 65–74 (33.2 DALYs per 1,000 population) and 75–84 (54.3 DALYs per 1,000 population). The total disease burden due to COPD was split fairly evenly between non-fatal burden (51%) and fatal burden (49%) in 2015 (AIHW 2019a).

For both men and women, the rate of total burden (DALY) increased with age, peaking at ages 85–94 then decreasing. The rate of fatal burden (YLL) followed a similar pattern. However, the rate of non-fatal burden (YLD) for men was highest among those aged 75–84 (Figure 2).

Figure 2: Burden of disease due to COPD, people aged 45 and over, age-specific rate, by sex and age group, 2015

Variation across population groups

The disease burden due to COPD varies in different population groups. The COPD DALY rate in Remote and very remote areas was 1.3 times as high as in Major cities. Meanwhile, the COPD DALY rate in the lowest socioeconomic area was 1.8 times as high as in the highest group.

Figure 3: Burden of disease due to COPD, age-standardised rate, by remoteness and socioeconomic area, 2015

Disease expenditure

How much does COPD cost the health system?

In 2015–16, COPD cost the Australian health system an estimated $977 million, representing 24% of disease expenditure on respiratory conditions and 0.8% of total disease expenditure (AIHW 2019b). This expenditure consisted of:

• $536 million for hospitals (55% of total expenditure on COPD)
• $189 million for non-hospital medical services (19%)
• $252 million for pharmaceuticals (26%)

Figure 4: Health expenditure on COPD, by area of expenditure and sex, 2015–16