(Chest. 2003;124:90-93.)
© 2003
American College of Chest Physicians
Age-Related Trends in Mortality From COPD in Lithuania, 1989 to 1998*
Vita Lesauskaite, PhD
* From the Geriatric Clinic, Kaunas University of Medicine, Kaunas, Lithuania.
Correspondence to: Vita Lesauskaite, PhD, Head, Geriatric Clinic, Kaunas University of Medicine, Mickeviciaus str. 9, Kaunas 3000, Lithuania; e-mail: lesauskaitevi{at}takas.lt
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Abstract
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Objective: To assess the age-related trends in mortality from COPD in middle-aged and elderly populations of Lithuania during a 10-year period (1989 to 1998).
Methods: Annual mortality was reported as the age-standardized mortality rates. Mortality rates were standardized to the 1989 European population. Trends in mortality were assessed by logarithmic regression coefficient ß that, expressed by percentage, estimated the average annual change in mortality.
Results: Analysis of mortality from COPD in the Lithuanian population during this 10 years revealed that mortality rates directly related to older age, and the indexes of men in various age groups were twofold to threefold greater than those of women. Annual change in mortality assessed by logarithmic regression coefficient in men aged 35 to 64 years was - 5.7% (p = 0.002) and in age group 
65 years it was - 2.9% (p = 0.001); in women, the change in mortality was - 7.2% (p = 0.006) and - 2.5% (p = 0.03), respectively.
Conclusion: Mortality from COPD in Lithuania during the 10-year period was decreasing in middle-aged and elderly populations and in both men and women. Decrease in mortality occurred at a slower rate in the elderly population than in middle-aged population.
Key Words: COPD • elderly • mortality
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Introduction
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Due to its impact on morbidity, disability, mortality, and quality of life, COPD represents a major health issue in many regions all over the world. Nevertheless, its epidemiology and burden on health care differs from country to country. Data of our investigations have shown a large, stable, and evenly distributed prevalence of COPD in Kaunas (a typical midsized city of the Baltic States with a population of 400,000) and five rural regions.1
2
This article describes age-related mortality rates and trends in mortality from COPD in Lithuania during 10 years.
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Materials and Methods
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Data were obtained for 10-year period from 1989 to 1998 from the Statistics Department in the Lithuanian Government. All deaths occurring in Lithuania are included by law in the vital statistics death registration system. Thus, mortality statistics provided by the Statistics Department are not estimates. The cause of death coded and tabulated on the National Mortality Database is the underlying cause of death, which is defined as either the disease or injury that initiated events leading directly to death, or the circumstances of the accident or violence that produced the fatal injury. The information on causes of death is coded and tabulated according to the ninth revision of the International Classification of Diseases (ICD-9). To describe COPD as primary cause of death, ICD-9 codes 490–496 were selected. The influence of COPD as the primary cause of death could not be separated from the influence of COPD as a contributing cause of death, since the National Mortality Database only codes for the primary cause of death.
Annual mortality was reported as the age-standardized mortality rates. Age-standardized mortality rates relate the number of deaths (per 100,000 population) to the population that would have occurred if the age distribution of that population were the same as that of the standard population at a particular time. Mortality rates were standardized to the 1989 European population. Data are presented separately for middle-aged (35 to 64 years) and elderly ( 65 years) men and women.
Trends in mortality were assessed by logarithmic regression coefficient ß, which estimated the change of an index in a period of time. Multiplied by 100, it estimated the average annual change in mortality in percentage. The value below zero of the logarithmic regression coefficient showed the decline, and the value above zero showed the increase of the analyzed index in a period of time.
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Results
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Ten-year (1989 to 1998) mortality data on COPD (ICD-9 codes 490–496) obtained from the Statistics Department of Lithuania were analyzed. Mean mortality rates due to COPD between 1989 and 1991 and between 1996 and 1998, starting with the age group of 35 to 39 years, are shown in Figure 1
. According to these data, there was a strong positive association in mortality from COPD with aging in men and women. Mean mortality rate in men between 1989 and 1991 in the age group of 35 to 39 years was 3.79/100,000; in the age group of 75 to 79 years, it was 590.62/100,000. In women, mean mortality rate was 2.36/100,000 and 160.02/100,000, respectively. Mean mortality rate in men between 1996 and 1998 in the age group of 35 to 39 years was only 1.61/100,000, and in the age group of 75 to 79 years was 566.71/100,000; in women, mean mortality rate was 0.89/100,000 and 146.54/100,000, respectively. Mortality of Lithuanian men associated with COPD in various age groups was twofold to threefold greater than that of women. Mean mortality rates from COPD between 1996 and 1998 were lower in many age groups, both in men and women, as compared with rates between 1989 and 1991. In absolute numbers, deaths that occurred among men due to COPD in all age groups were 2,946 during the period of 1989 to 1991 and 2,343 during the period of 1996 to 1998; in women, 1,473 and 1,235 deaths occurred, respectively. Trends in mortality due to COPD in middle-aged (35 to 64 years) and elderly ( 65 years) men and women during 10 years are shown in Figure 2
. According to logarithmic regression analysis, mortality from COPD was decreasing. The annual change in mortality associated with COPD in Lithuanian men aged 35 to 64 years was - 5.7% (p = 0.002), and in the elderly ( 65 years) was - 2.9% (p = 0.001); in women, the annual change was - 7.2% (p = 0.006) and - 2.5% (p = 0.03), respectively. Thus, mortality from COPD was decreasing faster in the middle-aged group than in the elderly group.
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Figure 1. Mean mortality rates (per 100,000 men and women) for COPD (ICD-9 codes 490–496) in Lithuania, from 1989 to 1991 and from 1996 to 1998. *Significant difference between mean mortality rates in periods from 1989 to 1991 and from 1996 to 1998 at p < 0.05.
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Figure 2. Age-standardized mortality rates (per 100,000 population) for COPD (ICD codes 490–496) in Lithuania, 1989 to 1998, in two age groups (35 to 64 years and 65 years), presented in logarithmic scale. All mortality rates were adjusted for the European population. b = mean annual change.
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Discussion
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According to the data sources from epidemiologic studies in various countries, mortality from COPD was increasing until 1985.3
Several years later, it was stated that mortality in men from COPD had leveled off, but it was still increasing in women4
; however, in some countries, the rise in mortality from COPD was observed until 1995.5
During the last decade of the 20th century in the United States and other developed countries of the world, mortality due to COPD began to decline. The greatest mortality rates due to COPD remain in East Europe, Romania, Ireland, and Scotland, and the smallest mortality rates are in South Europe, Japan, and Israel.6
Lithuania ranks with other East European countries with a large prevalence of and mortality from COPD.2
7
In our study, mortality of Lithuanian men associated with COPD in various age groups was twofold to threefold greater than that of women. These findings correspond with the data of previous studies in epidemiology of COPD.7
Improved management of COPD, including primary and secondary prevention,8
oxygen therapy,9
regular or as-needed use of bronchodilators,10
oral antibiotics,11
and anti-inflammatory agents12
in acute exacerbations, probably caused a decline in mortality from COPD in many countries. However, until recently, only smoking cessation and long-term oxygen therapy are proven to decrease mortality from COPD. Which factors could be the most important impacting the decrease in mortality from COPD in Lithuania? One of them could be the decrease in prevalence of smoking, especially in middle-aged men. Prospective epidemiologic studies in Kaunas have shown that in a 20-year period, the current rate of smoking in middle-aged men decreased from 45.0 to 33.5%; and those who continue to smoke are smoking less.13
In women, prevalence of smokers was low, approximately 4%, and did not change significantly. Until recently, long-term oxygen therapy was used rarely in Lithuania. Modernization of industry and closure of many old-fashioned factories caused a decrease of industrial pollution and probably could contribute to a fall in mortality from COPD. Important issue both for middle-aged and elderly populations seems to be changes in treatment: regular use of inhaled medications, corticosteroids, antibiotics in exacerbations, and broader use of pulmonary rehabilitation.14
15
The most important physiologic changes associated with aging are as follows: (1) a decrease in the static elastic recoil of the lung, (2) a decrease in compliance of the chest wall, and (3) a decrease in the strength of the respiratory muscles. Most of the changes described are related to these three phenomena.16
The aforementioned physiologic changes that occur in the process of aging and those due to summary effect of exposure to noxious environmental factors do lead to a higher incidence and prevalence of acute and chronic respiratory diseases in the elderly as compared to younger subjects. There is also a significantly higher mortality as shown in our investigation.
According to our data, the mean annual fall in mortality during the 10-year period, as expressed by logarithmic regression coefficient ß, was greater in middle-aged persons than in the elderly population. Observed difference could be associated to multiple factors such as the following: (1) the aging process itself increasing the probability of death, (2) aforementioned physiologic changes in the respiratory system due to the process of senescence resulting in the loss of compensatory reserve, (3) cumulative effect of risk factors (smoking, air pollution, etc), (4) comorbidity, and (5) psychosocial conditions (low income, poor cognitive performance, isolation) restricting access to expensive modern medications and oxygen therapy. Despite decreasing mortality, COPD continues to be a significant burden and causes major consumption of health-care resources in many populations, including the Baltic States, due to its costly management and impact on quality of life.17
18
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Conclusion
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Analysis of mortality from COPD (ICD-9 codes 490–496) in the Lithuanian population, during a 10-year period from 1989 to 1998, revealed that mortality rates directly related to older age, and the indexes of men in various age groups were twofold to threefold greater than those of women. Mortality from COPD in Lithuania was decreasing in middle-aged (35 to 64 years) and the elderly ( 65 years) populations and both in men and women. Decrease in mortality from COPD moved at a slower rate in the elderly population than in middle-aged population.
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Acknowledgements
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The author thanks Professor Jadvyga Petrauskiene from the Social Medicine Department for her assistance in providing the data, Mrs. Zita Stanioniene for her support in preparing the figures, and Erin Rader, RN, MSN, in Cleveland, OH, for editorial assistance.
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Footnotes
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Abbreviation: ICD-9 = ninth revision of the International Classification of Diseases
Received for publication March 13, 2002.
Accepted for publication January 6, 2003.
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References
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Abstract
Introduction
