Mortality data for COPD and asthma described in this study are from Vital Statistics of Canada, the US National Center for Health Statistics, L’Institut National de la Santё et de la Recherche Ntedicale for France, and issues of World Health Statistics Annual of the World Health Organization (WHO). Comparisons of death rates from 1969 to 1983 are made between the US, France and Canada for age groups 55-64 years, 65-74 years and 75-84 years. For years prior to 1974, data from Canada were not available. The focus is on mortality from COPD. Brief mention is made of trends for asthma because in adults the distinction between these diseases as causes of death is not always clear. Indeed, the WHO combines them in its reports on mortality by country.

The diagnostic categories for COPD and asthma used between 1969 and 1978, in the 8th Revision of the International Classification of Diseases (ICD), are given in Table 1, which also shows the numbers of deaths in 1978 in the three countries. Inclusion of “other diseases of the respiratory system” is discussed below During the 8th revision, there was no category in France for COPD not specified as bronchitis or emphysema, but the US and Canada introduced a special code (519.3), “chronic obstructive lung disease without mention of asthma, bronchitis or emphysema” (COLD). As more and more US and Canadian death certificates contained nonspecific terminology for COPD instead of bronchitis or emphy­sema, there was a large increase in the proportion of COPD and asthma deaths classified as COLD, as well as an increase in the total. By 1978, there were more deaths attributed to COLD than to emphysema and bronchitis combined in the US. Code 519.3 comprised 57 percent and 38 percent, respectively, of all COPD and asthma deaths in the US and Canada. The effects of this on mortality comparisons with France will be described.
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Table 1—Distribution of deaths from COPD and Asthma in men and women ай ages. United States, Canada and France in 1978 and 1979

Cause of death

United States

Canada

France

1978

1979

1978

1979

1978

1979

COPD and Asthma

100.0

100.0

100.0

100.0

100.0

100.0

(Numbers of
deaths)

50,490

49,933

4,729

4,620

7,241

11,076

Bronchitis
unqualified
(490)*

1.5

0.8

3.4

1.3

19.8

12.3

Chronic
bronchitis
(491)

7.1

6.5

24.9

20.0

42.0

25.7

Emphysema
(492)

31.0

27.2

27.1

23.8

17.1

9.2

Asthma
(493)

3.7

5.2

6.4

8.6

21.1

13.6

Chronic
obstructive lung disease

without mention
of asthma, bronchitis

or emphysema
(519.3)

56.7

38.2

t

Other diseases of
the respiratory

system
(519.9)

n = 819

n = 51

n=5,354

Chronic airways
obstruction not

elsewhere
classified
(496)$$

60.3

46.3

39.2

Beginning in 1979, the ICD/9 codes for COPD and asthma were 490-492 and 493 respectively. Death certificates containing gener­alized terminology such as COLD were classified to code 496, “chronic airways obstruction, not elsewhere classified” (NEC). By basing COPD and asthma mortality for years 1979-83 on ICD/9 codes 490-493,496 (490-496 for the US), comparison is enhanced over that possible from WHO publications which omit deaths classified to chronic airways obstruction (496).

The total number of deaths from COPD and asthma in France increased from 7,247 in 1978 to 11,076 in 1979 because of the exclusion of a generalized COPD category in ICD/8 and inclusion of code 496 in ICD/9. The number of deaths from chronic bronchitis, emphysema, or asthma did not change appreciably in 1979 as compared with 1978. In an attempt to improve comparability of time trends in France across these two ICD revisions, mortality for the category 519.9 “Other diseases of the respiratory system,” for 1969 to 1978 is also analyzed. This is a large category of mortality in France and it presumably contains deaths certified to generalized COPD. tadalis sx 20

Category: Diseases / Tags: asthma, Mortality, Pulmonary Diseases

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