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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

  1. 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.

  2. 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.

  3. 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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