Supplementary Information

Changing causes of death for chronic respiratory disease patients in England, 2005-2015

Alicia V Gayle, Eleanor L Axson, Chloe I Bloom, Vidya Navaratnam, Jennifer K Quint

Figure 1. Flow chart of patient inclusion. CRD includes asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Disease component numbers do not sum to total numbers as patients were able to be part of multiple disease groups.

Figure 2. Age-standardised mortality (ASM) per 100,000 population compared to the general population, 2005-2015. Presented for all patients with: asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Rates compared to the general population. Groups differentiated as ‘only’ refer to those patients with that respiratory disease and no other respiratory disease comorbidities. Disease group presented are mutually exclusive. pop = population.

Figure 3. Leading Causes of Death among CRD patients by disease. Presented as percentages of all deaths per year for the overall CRD and by individual disease; including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioural disorders) and G (diseases of the nervous system) have been combined. ‘Other’ refers to causes of death categorized in all ICD-10 chapters outside of C, D00-48, F, G, I, J, and K.

Figure 4. Trends in leading causes of death in the chronic respiratory disease (CRD) population, 2005-2015. Presented as % of all deaths per year for the overall CRD population; including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioural disorders) and G (diseases of the nervous system) have been combined. ‘Other’ refers to causes of death categorized in all ICD-10 chapters outside of C, D00-48, F, G, I, J, and K. Significant p-values (α < 0.05) from Chi-squared test for trend are shown.

Methods

CPRD Medcodes

COPD codes additional to validated list

104608, 104710, 104985, 105457, 106637, 65733, 67040, 60188, 46578, 16410

Validated list published as: Quint JK, Mullerova H, DiSantostefano RL, et al. Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD). BMJ Open 2014; 4(7): e005540.

 

Base CRD Cohort n (%)

Base Asthma Cohort n (%)

Base Bronchiectasis Cohort n (%)

Base COPD Cohort n (%)

Base ILD Cohort n (%)

Number of Patients

558,888

451,830

19,374

137,709

10,745

 

Female

309,191

(55.3)

260,484

(57.7)

11,083

(57.2)

65,060

(47.2)

4,056

(37.8)

 

Age at Start, years (mean, SD)

Males

48.8 ± 21.0

42.4 ± 18.6

64.2 ± 15.8

69.0 ± 12.1

69.8 ± 13.4

Females

48.1 ± 21.0

43.8 ± 19.3

64.7 ± 16.0

69.2 ± 12.9

69.4 ± 15.3

 

Age Groups at Start

18-24 years

91,501 (16.4)

91,166 (20.2)

448 (2.31)

0 (0.00)

63 (0.59)

25-34 years

88,386 (15.8)

87,856 (19.4)

634 (3.27)

294 (0.21)

179 (1.67)

35-44 years

83,670 (15.0)

81,212 (18.0)

1,187 (6.13)

4,060 (2.95)

459 (4.27)

45-54 years

70,175 (12.6)

62,091 (13.7)

1,999 (10.3)

13,188 (9.58)

822 (7.65)

55-64 years

75,355 (13.5)

54,006 (12.0)

4,422 (22.8)

30,660 (22.3)

1,732 (16.1)

65-74 years

72,044 (12.90)

41,726 (9.23)

5,170 (26.7)

39,898 (29.0)

2,935 (27.3)

75-84 years

55,731 (10.0)

25,679 (5.68)

3,988 (20.6)

35,129 (25.5)

3,289 (30.6)

85+ years

22,026 (3.94)

8,094 (1.79)

1,526 (7.88)

14,480 (10.5)

1,266 (11.8)

 

Smoking Status

Never Smoker/Not Recorded

260,246 (46.6)

234,675 (51.9)

9,882 (51.0)

26,598 (19.3)

4,468 (41.6)

Current Smoker

134,947 (24.2)

100,901 (22.3)

2,198 (11.4)

47,472 (34.5)

1,234 (11.5)

Former Smoker

163,695 (29.3)

116,254 (25.7)

7,294 (37.7)

63,639 (46.2)

5,043 (46.9)

 

Body Mass Index (kg/m²)

Underweight (< 18.5)

18,367 (3.78)

12,716 (3.22)

1,062 (6.25)

6,522 (5.39)

283 (3.07)

Healthy Weight (18.5-24.9)

181,412 (37.3)

146,872 (37.2)

6,973 (41.0)

42,639 (35.2)

3,062 (33.2)

Overweight (25.0-29.9)

154,578 (31.8)

125,226 (31.7)

5,570 (32.8)

39,474 (32.6)

3,518 (38.2)

Obese (>= 30)

132,148 (27.2)

110,264 (27.9)

3,397 (20.0)

32,458 (26.8)

2,356 (25.6)

 

 

Diagnosis of Asthma

451,830 (80.8)

~

6,539 (33.8)

46,653 (33.9)

1,580 (14.7)

Diagnosis of Bronchiectasis

19,374 (3.47)

6,539 (1.45)

~

6,625 (4.81)

744 (6.92)

Diagnosis of COPD

137,709 (24.6)

46,653(10.3)

6,625 (34.2)

~

2,635 (24.5)

Diagnosis of ILD

10,745 (1.92)

1,580 (0.35)

744 (3.84)

2,635 (1.91)

~

Diagnosis IPF

1,380 (0.25)

141 (0.03)

81 (0.42)

307 (0.22)

1,380 (12.8)

Diagnosis Pneumoconiosis

1,931 (0.35)

312 (0.07)

87 (0.45)

670 (0.49)

1,931 (18.0)

Diagnosis Sarcoidosis

1,271 (0.23)

201 (0.04)

48 (0.25)

105 (0.08)

1,271 (11.8)

 

Index of Multiple Deprivation

1- Most Deprived

111,370 (19.9)

94,134 (20.9)

4,794 (24.8)

20,358 (14.8)

2,265 (21.1)

2-

116,210 (20.8)

95,381 (21.1)

4,541 (23.5)

25,798 (18.8)

2,405 (22.4)

3-

115,460 (20.7)

93,627 (20.7)

3,803 (19.6)

27,888 (20.3)

2,314 (21.6)

4-

111,209 (19.9)

88,367 (19.6)

3,162 (16.3)

30,623 (22.3)

1,965 (18.3)

5- Least Deprived

104,161 (18.7)

79,937 (17.7)

3,067 (15.8)

32,923 (23.9)

1,790 (16.7)

Number of Patient Deaths

75,789 (13.6)

27,656 (6.12)

5,446 (28.1)

54,320 (39.4)

5,249 (48.9)

S1. Descriptive statistics of the Chronic Respiratory Disease (CRD) patient cohort.

Age (years)

Sex

Never Smoker/Not Recorded

Former Smoker

Current Smoker

20-24

F

27 (23-28)

0 (0-0)

127 (123-131)

M

31 (30-32)

174 (160-188)

47 (45-49)

25-34

F

26 (23-26)

26 (25-26)

204 (199-210)

M

24 (23-24)

85 (81-88)

256 (249-263)

35-44

F

115 (112-117)

59 (57-60)

553 (539-567)

M

201 (197-205)

278 (269-287)

304 (296-312)

45-54

F

238 (234-242)

233 (227-240)

729 (711-747)

M

367 (359-374)

537 (521-553)

1,256 (1,220-1,292)

55-64

F

558 (548-568)

1,043 (1,019-1,068)

2,191 (2,136-2,247)

M

860 (839-880)

1,325 (1,294-1,357)

2,872 (2,793-2,952)

65-74

F

1,731 (1,696-1,766)

2,604 (2,549-2,660)

4,849 (4,709-4,990)

M

2,871 (2,792-2,951)

3,669 (3,597-3,742)

6,842 (6,640-7,044)

75-84

F

5,094 (4,980-5,208)

7,459 (7,286-7,631)

13,601 (13,050-14,153)

M

7,359 (7,117-7,600)

9,217 (9,021-9,413)

15,197 (14,519-15,875)

85+

F

17,947 (17,381-18,512)

17,465 (16,834-18,096)

18,507 (17,106-19,909)

M

12,697 (12,122-13,252)

21,161 (20,399-21,923)

17,384 (16,204-18,745)

S2. Crude mortality rates stratified by age, sex, and smoking status in 2010. Mortality (95% CI) per 100,000 population. Presented for males (M) and females (F) by age group and smoking status.

 

CRD Cohort

Asthma

Bronchiectasis

COPD

ILD

Body Mass Index (kg/m²)

Underweight (< 18.5)

6,724 (6,561-6,886)

2,702 (2,624-2,780)

12,984 (11,769-14,199)

15,398 (14,774-16,022)

21,250 (16,593-25,907)

Healthy Weight (18.5-24.9)

2,719 (2,701-2,737)

1,138 (1,129-1,146)

4,379 (4,244-4,514)

7,830 (7,724-7,936)

11,944 (11,272-12,616)

Overweight (25-29.9)

2,398 (2,381-2,414)

1,106 (1,097-1,114)

3,449 (3,334-3,564)

5,594 (5,520-5,669)

11,823 (11,227-12,419)

Obese (>= 30)

2,057 (2,042-2,072)

1,045 (1,037-1,053)

2,290 (2,193-2,387)

4,945 (4,873-5,017)

8,209 (7,718-8,700)

Index of Multiple Deprivation

I - Most Deprived

2,128 (2,110-2,145)

918 (910-926)

4,203 (4,049-4,356)

6,925 (6,793-7,058)

10,554 (9,885-11,222)

II

2,572 (2,551-2,593)

1,133 (1,123-1,143)

3,873 (3,727-4,019)

6,999 (6,880-7,119)

10,061 (9,432-10,690)

III

2,576 (2,555-2,598)

1,160 (1,149-1,170)

4,269 (4,092-4,445)

6,732 (6,621-6,842)

12,128 (11,352-12,903)

IV

2,916 (2,891-2,941)

1,241 (1,229-1,253)

4,608 (4,392-3,823)

7,007 (6,896-7,117)

12,798 (11,909-13,687)

V - Least Deprived

3,212 (3,183-3,240)

1,443 (1,429-1,458)

5,226 (4,980-5,473)

6,775 (6,673-6,877)

10,544 (9,803-11,305)

S3. Crude mortality rates stratified by BMI and IMD in 2010. Presented for overall CRD cohort and sub-cohorts. Data are presented as mortality (95% CI), per 100,000 population. Rates have been calculated using a mid-year population estimate for 2010. BMI = body mass index (kg/m2); IMD = Index of Multiple Deprivation; CRD = chronic respiratory disease including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD).

N

N Deaths

Crude Mortality Rate

ASMR

General Population

57,885,413

5,477,290

1,178 (1,177 – 1,178)

867 (867 - 868)

CRD Patients

558,888

75,789

3,030 (3,022 - 3,038)

1,607 (1,603 - 1,611)

Asthma only

400,783

15,153

808 (805 - 810)

787 (784 - 789)

Bronchiectasis only

8,789

2,159

4,692 (4,594 - 4,790)

1,559 (1,527 - 1,592)

COPD only

85,632

39,468

11,032 (10,958 -11,106)

3,106 (3,085 - 3,126)

ILD only

6,831

3,312

12,698 (12,397 - 12,999)

3,755 (3,666 - 3,844)

S4. Mortality rates stratified by CRD, 2004 - 2015. Presented for overall CRD cohort and sub-cohorts without comorbid respiratory diseases. Data are presented as mortality (95% CI), per 100,000 population. Rates have been calculated by averaging over mid-year population estimates for each year. Age standardised mortality rate (ASMR). CRD = chronic respiratory disease including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD).

 

Chapter (ICD-10)

N

% of all deaths

CRD

Asthma

Bronchiectasis

COPD

ILD

Diseases of the respiratory system

(J00-J99)

24,363

32%

24%

41%

36%

49%

Diseases of the circulatory system

(I00-I99)

19,410

26%

28%

21%

25%

20%

Neoplasms

(C00-D48)

18,341

24%

27%

18%

23%

17%

Diseases of the digestive system

(K00-K93)

3,228

4%

5%

4%

4%

3%

Mental and behavioural disorders

(F00-F99)

3,172

4%

4%

5%

4%

3%

External causes of morbidity

(V01-Y98)

1,757

2%

4%

2%

2%

1%

Diseases of the nervous system

(G00-G99)

1,507

2%

2%

3%

2%

1%

Diseases of the genitourinary system

(N00-N99)

1,204

2%

2%

2%

2%

1%

Certain infectious and parasitic diseases

(A00-B99)

839

1%

1%

1%

1%

1%

Endocrine, nutritional and metabolic diseases

(E00-E90)

774

1%

1%

1%

1%

1%

Diseases of the musculoskeletal system and connective tissue

(M00-M99)

562

1%

1%

1%

1%

2%

Diseases of the skin and subcutaneous tissue

(L00-L99)

236

0%

0%

0%

0%

0%

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)

162

0%

0%

1%

0%

1%

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

(R00-R99)

153

0%

0%

0%

0%

0%

Congenital malformations, deformations and chromosomal abnormalities

(Q00-Q99)

71

0%

0%

0%

0%

0%

Provisional assignment of new diseases of uncertain aetiology or emergency use

(U00-U49)

6

0%

0%

0%

0%

0%

Diseases of the eye and adnexa, the ear and mastoid process

(H00-H95)

< 5

0%

0%

0%

0%

0%

Pregnancy, childbirth and the puerperium

(O00-O99)

< 5

0%

0%

0%

0%

0%

Total

75,789

100%

100%

100%

100%

100%

S5. Causes of death by ICD-10 chapter. Using ONS derived cause of death. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).

CRD

Asthma

Bronchiectasis

COPD

ILD

Chapter (ICD-10)

N

% all deaths

% chapter

N

% all deaths

%

chapter

N

% all deaths

% chapter

N

% all deaths

% chapter

N

% of all deaths

% chapter

Diseases of the Respiratory System (J00-J99)

24,363

32%

100%

2,148

14%

32%

616

29%

100%

13,784

35%

70%

1,595

48%

62%

COPD

16,043

21%

66%

635

4%

9%

108

5%

18%

11,102

28%

57%

90

3%

3%

Pneumonia

3,230

4%

13%

776

5%

12%

136

6%

22%

1,559

4%

8%

134

4%

5%

Idiopathic pulmonary fibrosis

1,812

2%

7%

42

0%

1%

27

1%

4%

136

0%

1%

1,112

34%

43%

Bronchiectasis

853

1%

4%

22

0%

0%

280

13%

45%

101

0%

1%

9

0%

0%

Asthma

592

1%

2%

338

2%

5%

6

0%

1%

112

0%

1%

<5

0%

0%

Lung disease due to external agents

551

1%

2%

83

1%

1%

17

1%

3%

247

1%

1%

67

2%

3%

Influenza

12

0%

0%

5

0%

0%

0

0%

0%

<5

0%

0%

0

0%

0%

Other

1,270

2%

5%

247

2%

4%

42

2%

7%

527

1%

3%

183

6%

7%

Diseases of the Circulatory System (I00-I99)

19,410

26%

100%

4,670

31%

60%

544

25%

100%

9,783

25%

73%

700

21%

100%

Ischaemic Heart Disease

9,565

13%

49%

2,171

14%

28%

245

11%

45%

4,834

12%

36%

385

12%

55%

Cerebrovascular Disease

4,035

5%

21%

1,033

7%

13%

135

6%

25%

2,038

5%

15%

130

4%

19%

Heart Failure

971

1%

5%

230

2%

3%

29

1%

5%

496

1%

4%

36

1%

5%

Other

4,839

6%

25%

1,236

8%

16%

135

6%

25%

2,415

6%

18%

149

4%

21%

Neoplasms

(C00-D48)

18,341

24%

100%

4,456

29%

60%

443

21%

100%

9,393

24%

74%

539

16%

100%

Lung Cancer

6,857

9%

37%

833

5%

11%

82

4%

19%

4,346

11%

34%

190

6%

22%

Prostate Cancer

979

1%

5%

233

2%

3%

25

1%

6%

501

1%

4%

33

1%

4%

Breast Cancer

864

1%

5%

403

3%

5%

32

1%

7%

268

1%

2%

26

1%

3%

Pancreatic Cancer

774

1%

4%

253

2%

3%

25

1%

6%

329

1%

3%

20

1%

2%

Bladder Cancer

562

1%

3%

107

1%

1%

17

1%

4%

312

1%

2%

16

0%

2%

Pleural Mesothelioma

30

0%

0%

10

0%

0%

<5

0%

0%

13

0%

0%

<5

0%

0%

Other

8,305

11%

45%

2,627

17%

35%

262

12%

59%

9,393

24%

74%

254

8%

29%

Mental and behavioural disorders and Diseases of the nervous system

(F00-G99)

4,679

6%

100%

1,190

8%

100%

258

12%

100%

2,524

6%

100%

148

4%

100%

Diseases of the digestive system (K00-K93)

3,228

4%

100%

910

6%

100%

89

4%

100%

1,479

4%

100%

89

3%

100%

TOTAL

70,021

92%

 

13,374

88%

 

1,950

90%

 

36,963

94%

 

3,071

93%

 

S6. Causes of death by underlying CRD for patients without comorbid CRD. Presented as counts, % of all deaths, and % of deaths within ICD-10 chapter. Values rounded to nearest whole number. CRD = chronic respiratory disease including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioral disorders) and G (diseases of the nervous system) have been combined.

 

Chapter (ICD-10)

N

% of all deaths

CRD

Asthma

Bronchiectasis

COPD

ILD

Diseases of the respiratory system

(J00-J99)

30,523

40%

26%

41%

43%

54%

Diseases of the circulatory system

(I00-I99)

16,546

22%

26%

20%

21%

20%

Neoplasms

(C00-D48)

14,404

19%

24%

15%

19%

12%

Mental and behavioural disorders

(F00-F99)

3,349

4%

5%

8%

5%

4%

Certain infectious and parasitic diseases

(A00-B99)

2,941

4%

4%

4%

4%

4%

Diseases of the digestive system

(K00-K93)

2,393

3%

4%

3%

3%

3%

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

(R00-R99)

1,687

2%

3%

3%

2%

2%

Diseases of the genitourinary system

(N00-N99)

1,438

2%

2%

2%

2%

1%

External causes of morbidity

(V01-Y98)

1,335

2%

4%

2%

1%

1%

Diseases of the nervous system

(G00-G99)

785

1%

2%

2%

1%

1%

Endocrine, nutritional and metabolic diseases

(E00-E90)

175

0%

0%

0%

0%

0%

Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

(D50-D89)

128

0%

0%

0%

0%

0%

Diseases of the musculoskeletal system and connective tissue (M00-M99)

37

0%

0%

0%

0%

0%

Diseases of the skin and subcutaneous tissue

(L00-L99)

36

0%

0%

0%

0%

0%

Provisional assignment of new diseases of uncertain aetiology or emergency use

(U00-U49)

6

0%

0%

0%

0%

0%

Congenital malformations, deformations and chromosomal abnormalities

(Q00-Q99)

5

0%

0%

0%

0%

0%

Pregnancy, childbirth and the puerperium

(O00-O99)

<5

0%

0%

0%

0%

0%

Diseases of the eye and adnexa, the ear and mastoid process

(H00-H95)

0

0%

0%

0%

0%

0%

Total

75,789

100%

100%

100%

100%

100%

S7. Causes of death by chapter. Using the ICD-10 code in first position on death certificate.

S8. Leading causes of death in each chronic respiratory disease population, 2005-2014. Presented as % of all deaths per year for asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Significant p-values (α < 0.05) from Cochran-Armitage test for trend are shown.

S9. Trends in leading causes of death in the chronic respiratory disease (CRD) population by age, 2005-2015. Presented as % of all deaths per year for the overall CRD population; including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioural disorders) and G (diseases of the nervous system) have been combined. ‘Other’ refers to causes of death categorized in all ICD-10 chapters outside of C, D00-48, F, G, I, J, and K.