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Trends in Cause-Specific Mortality in Oxygen-dependent Chronic Obstructive Pulmonary Disease

Ekstrom, Magnus; Wagner, Philippe LU and Ström, Kerstin LU (2011) In American Journal of Respiratory and Critical Care Medicine 183(8). p.1032-1036
Abstract
Rationale: Since the introduction of long-term oxygen treatment (LTOT) in chronic obstructive pulmonary disease (COPD) with chronic hypoxia, the proportion of women and the age of patients starting LTOT have increased markedly. We hypothesize that this might have led to shifts in the causes of death over time. Objectives: To test for time trends in cause-specific mortality in COPD with LTOT. Methods: Patients starting LTOT for COPD in Sweden between January 1, 1987 and December 31, 2004 were included in a national prospective study and monitored until withdrawal of LTOT, death, or December 31, 2004. The primary end point was cause of death obtained from the Swedish Causes of Death Register. Measurements and Main Results: A total of 7,628... (More)
Rationale: Since the introduction of long-term oxygen treatment (LTOT) in chronic obstructive pulmonary disease (COPD) with chronic hypoxia, the proportion of women and the age of patients starting LTOT have increased markedly. We hypothesize that this might have led to shifts in the causes of death over time. Objectives: To test for time trends in cause-specific mortality in COPD with LTOT. Methods: Patients starting LTOT for COPD in Sweden between January 1, 1987 and December 31, 2004 were included in a national prospective study and monitored until withdrawal of LTOT, death, or December 31, 2004. The primary end point was cause of death obtained from the Swedish Causes of Death Register. Measurements and Main Results: A total of 7,628 patients (53% women) were monitored for a median of 1.7 years (range, 0-18.0 yr). No patient was lost to follow-up and 5,457 patients died during the study. The crude overall mortality increased by 1.6%/year (95% confidence interval [CI], 0.9-2.2%/yr; P < 0.001). The absolute risk of death increased for circulatory disease by 2.8%/year (95% CI, 1.3-4.3%/yr; P < 0.001) and for digestive organ disease by 7.8%/year (95% CI, 1.9-14.0%/ yr; P = 0.009). The absolute risk of death decreased for respiratory disease by 2.7%/year (95% CI, 2.0-3.3%/yr; P < 0.001) and for lung cancer by 3.4%/year (95% CI, 1.1-5.7%/yr; P = 0.004). Conclusions: In oxygen-dependent COPD, mortality has increased over time both overall and of nonrespiratory causes, including cardiovascular disease. This highlights the importance of optimized diagnostics and treatment of comorbidities to decrease morbidity and mortality. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
mortality, COPD, oxygen inhalation therapy, comorbidity, survival
in
American Journal of Respiratory and Critical Care Medicine
volume
183
issue
8
pages
1032 - 1036
publisher
Am Thoracic Soc
external identifiers
  • wos:000289955600017
  • scopus:79954617458
  • pmid:21216882
ISSN
1535-4970
DOI
10.1164/rccm.201010-1704OC
language
English
LU publication?
yes
id
06e1342e-14b5-4021-adde-50200dcaf99b (old id 1964733)
date added to LUP
2011-05-23 14:19:04
date last changed
2017-06-11 03:23:46
@article{06e1342e-14b5-4021-adde-50200dcaf99b,
  abstract     = {Rationale: Since the introduction of long-term oxygen treatment (LTOT) in chronic obstructive pulmonary disease (COPD) with chronic hypoxia, the proportion of women and the age of patients starting LTOT have increased markedly. We hypothesize that this might have led to shifts in the causes of death over time. Objectives: To test for time trends in cause-specific mortality in COPD with LTOT. Methods: Patients starting LTOT for COPD in Sweden between January 1, 1987 and December 31, 2004 were included in a national prospective study and monitored until withdrawal of LTOT, death, or December 31, 2004. The primary end point was cause of death obtained from the Swedish Causes of Death Register. Measurements and Main Results: A total of 7,628 patients (53% women) were monitored for a median of 1.7 years (range, 0-18.0 yr). No patient was lost to follow-up and 5,457 patients died during the study. The crude overall mortality increased by 1.6%/year (95% confidence interval [CI], 0.9-2.2%/yr; P &lt; 0.001). The absolute risk of death increased for circulatory disease by 2.8%/year (95% CI, 1.3-4.3%/yr; P &lt; 0.001) and for digestive organ disease by 7.8%/year (95% CI, 1.9-14.0%/ yr; P = 0.009). The absolute risk of death decreased for respiratory disease by 2.7%/year (95% CI, 2.0-3.3%/yr; P &lt; 0.001) and for lung cancer by 3.4%/year (95% CI, 1.1-5.7%/yr; P = 0.004). Conclusions: In oxygen-dependent COPD, mortality has increased over time both overall and of nonrespiratory causes, including cardiovascular disease. This highlights the importance of optimized diagnostics and treatment of comorbidities to decrease morbidity and mortality.},
  author       = {Ekstrom, Magnus and Wagner, Philippe and Ström, Kerstin},
  issn         = {1535-4970},
  keyword      = {mortality,COPD,oxygen inhalation therapy,comorbidity,survival},
  language     = {eng},
  number       = {8},
  pages        = {1032--1036},
  publisher    = {Am Thoracic Soc},
  series       = {American Journal of Respiratory and Critical Care Medicine},
  title        = {Trends in Cause-Specific Mortality in Oxygen-dependent Chronic Obstructive Pulmonary Disease},
  url          = {http://dx.doi.org/10.1164/rccm.201010-1704OC},
  volume       = {183},
  year         = {2011},
}