Mortality Trends

Over the last 23 years we have made tremendous progress in treating many diseases. We have instituted measurements to decrease coronary artery disease. We have developed ways to identify patients in an acute stroke. As a consequence there has been a significant decrease in mortality from these diseases and this trend continues. Fewer people are dying of heart disease and cerebral vascular disease. As a result, the all-cause mortality rate has decreased and the life expectancy of both men and women has significantly increased.

Unfortunately, mortality due to COPD is going in the wrong direction. The mortality rate of COPD has continued to rise as more patients are being diagnosed. COPD claims over 120,000 lives per year in the United States. Thatis one death every four minutes. Thirty people will die of COPD while you are reading this monograph. More important, half of all those patients with COPD were only recently diagnosed while suffering a complication of the disease, primarily an exacerbation. Clinical studies are underway to try and identify patients sooner, because when the disease is diagnosed sooner our patients are going to have much better outcomes.

Another major change that has occurred in recent years is that the face of COPD has changed. Patients are no longer predominantly male. There are a large number of women who have COPD and have not been diagnosed.

Data from the CDC show the trend of mortality comparing males versus females. In the 1980s, there was a huge gap with men dying of COPD more than twice as often as women, but over the last 20 years the gap closed. Beginning in 2000 the death rate of women passed that of men, and that trend continues. Today the disease is more prevalent in women and is being identified more often in younger women. For some reason we don't understand, the disease has a more rapid progression in women than it does in men. In a woman in her 50s the disease will have progressed as far as it has in a man in his 60s or 70s. By the time the woman reaches her early 60s, she is going to be very debilitated or incapacitated—and very often she will only recently have been diagnosed.