Chronic obstructive pulmonary disease (COPD)

How many die from COPD?

COPD is a major leading cause of death in Australia. In 2017, 7,518 people were recorded as having died from COPD (4,005 men and 3,513 women) making it the fifth leading cause of death after coronary heart disease, dementia and Alzheimer disease, cerebrovascular disease, and lung cancer.

However, the attribution of cause of death in the elderly is often difficult, particularly in relation to COPD and asthma [1,2,3]. In the period 2007–2011, among those aged 55 and over in Australia, only 40% of deaths where COPD was listed on the death certificate had COPD listed as the underlying cause of death [4].

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.

Table 1: Leading five causes of death, 2017

Note: Deaths are for all ages.

Source: AIHW National Mortality Database.

COPD mortality has declined over time

Mortality from asthma and COPD in Australia [4] presents detailed analysis of COPD mortality for the period 1965 to 2010. In Australia, the COPD mortality rate among men aged 55 and over decreased by two thirds between 1970 and 2010, from 393 to 136 per 100,000 population. However, the COPD mortality rate among women in this age group increased between 1965 and 1996, from 36 to 103 per 100,000 population. Between 1996 to 2010, this rate then showed a small decrease, from 103 to 82 per 100,000 population (Figure 1).

Tobacco smoking is the predominant cause of COPD [5] and improvements in COPD mortality rates are expected to follow improvements in smoking rates, with a lag period of 20 to 30 years. In Australia, smoking rates among men decreased from 1945 onwards, and for women decreased from 1976 onwards. It is likely that the decrease in COPD mortality rates among women occurred later than for men because the decline in smoking rates for women occurred later.

Figure 1: COPD death rates of people aged 55 and over, 3-year moving average, and smoking rates, 1945 to 2010

Notes

1. Age-standardised to the 2001 Australian Standard Population.
2. Smoking data were calculated by the Cancer Council of Victoria. See Scollo and Winstanley 2012 for methodological details [6].
3. COPD classified according to ICD-7 codes 501, 502, 526, 527.1, ICD-8 codes 518, 490, 491, 492, 519.8, ICD-9 codes 490, 491, 492, 494, 496 and ICD-10 codes J40–J44, J47. In addition to COPD these codes include a condition called bronchiectasis which can be difficult to distinguish from COPD.
4.  This Figure and accompanying text will be updated to the most recent data in the near future.

Sources: [4,6] (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 [4]. COPD mortality rates are also higher among Indigenous Australians compared with non-Indigenous Australians after adjusting for differences in age-structure. During the period from 2013 to 2017, among those aged 45 and over, the mortality rate for COPD among Indigenous Australians was 198 per 100,000 population, which was 3 times that of non-Indigenous Australians (66 per 100,000 population), based on the five jurisdictions with adequate Indigenous identification (NSW, Qld, NT, WA and SA).

The differences between these population subgroups may be due to differences in smoking rates, access to preventative 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 [7].

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

References

1. Jones K, Berrill WT, Bromly CL & Hendrick DJ 1999. A confidential enquiry into certified asthma deaths in the north of England, 1994–96: influence of co-morbidity and diagnostic inaccuracy. Respiratory Medicine 93:923–7.
2. Sears MR, Rea HH, De Boer G, Beaglehole R, Gillies AJD, Holst PE et al. 1986. Accuracy of certification of deaths due to asthma. American Journal of Epidemiology 124:1004–11.
3. Smyth ET, Wright SC, Evans AE, Sinnamon DG & MacMahon J 1996. Death from airways obstruction: accuracy of certification in Northern Ireland. Thorax 51:293–7.
4. Australian Institute of Health and Welfare (AIHW): Poulos LM, Cooper SJ, Ampon R, Reddell HK and Marks GB 2014. Mortality from asthma and COPD in Australia. Cat. no. ACM 30. Canberra: AIHW.
5. Tamimi A, Serdarevic D & Hanania N 2012. The effects of cigarette smoke on airway inflammation in asthma and COPD: Therapeutic implications. Respiratory Medicine 106: 319–328.
6. Scollo, MM and Winstanley, MH 2012. Tobacco in Australia: Facts and issues: Prevalence of smoking—adults. 4th edn. Melbourne: Cancer Council Victoria.
7. AIHW 2018. Australia's health 2018. Australia's health series no. 16. Cat. no. AUS 221. Canberra: AIHW.