COPD tied to excess death risk, even in younger adults

Younger adults with chronic obstructive pulmonary disease (COPD) have excess risk of morbidity and mortality, contrary to common belief that the disease is mild at younger age, according to a longitudinal, population-base cohort study presented at the ATS 2021 Meeting.  

“COPD is generally considered a disease of older adults, but it can also affect younger patients,” said lead author Dr Alina Blazer from the University of Toronto in Toronto, Canada. “It is commonly assumed that COPD diagnosed earlier in life can be equated with milder severity. However, this has not been fully examined in a real-world population.”

Among younger adults (aged 35-55 years), those diagnosed with COPD had an overall mortality rate that was fivefold higher than their peers without COPD. [ATS 2021, abstract A1131]  

By contrast, the overall mortality rate among older adults (≥65 years) was 2.5-fold higher compared with their counterparts without COPD.

“Younger adults with COPD had elevated mortality rate compared to those without COPD … an elevation [that was] much more pronounced than in older people,” Blazer noted.

In the longitudinal, population-based cohort study, 194,759 adults aged 35-55 years in Ontario who had been diagnosed with COPD were identified using health claim data over a 2-year period. They were then compared with younger adults without COPD as well as older adults (≥65 years) with COPD.

Compared with their peers without COPD, younger adults with COPD showed higher rates of healthcare ultilization. Hospitalization for any cause was 3.1 times more frequent, visits to emergency department (ED) for any cause were 2.2 times more common, and all-cause outpatient visits were 1.7 times more often among younger adults with COPD than their peers without the disease. 

The corresponding rates for older adults with vs those without COPD were 2.1 times, 1.8 times, and 1.4 times higher, respectively. 

“[In particular, the] rates of all-cause ED visits among younger adults with COPD exceeded rates seen in adults without COPD, and approach rates seen in older patients with COPD,” reported Blazer, when comparing all groups together.

“Our data demonstrates that younger adults with COPD experience significant morbidity and excessive mortality from their disease. This study provides further evidence that ‘early’ COPD is not a benign entity,” Blazer highlighted.

“Clinical efforts should focus on targeting younger adults with COPD with earlier interventions that can improve their state of health and prevent further progression of their disease,” she suggested.

Nonetheless, she also noted that the data on mortality was documented for any cause, and information on the specific cause of death was unavailable. Understanding the actual causes would help elucidate how much of the increased mortality among younger patients were attributed to COPD, she added.