COPD and asthma death rates from 1969 to 1983 for the three countries for the 65-74 years age group, the middle age-group of our study, are shown in Table 2. Intercountry comparisons for this age group typify comparisons for the other age groups. The proportion of COPD and asthma deaths due to bronchitis is much higher in France (29 percent in 1983) than in the US (5 percent) and Canada (9 percent). There is greater mortality coded to the term chronic airways obstruc­tion NEC in Canada and the US than in France between 1979 and 1983. Between 1978 and 1979, there is no sudden increase in mortality from COPD and asthma in the US and Canada.

Because of the lack of a special category (519.3) for COLD during ICD/8 in France, however, there is a sudden increase, as deaths classified as chronic airways obstruction (496) are included beginning with ICD/9 in 1979. Apart from this sudden increase, trends for total COPD and asthma are markedly upward in the US, modestly upward in Canada, but not upwards in France.

For the total population (all ages), between 1979 and 1983, deaths coded chronic airways obstruction NEC increased in frequency and dominated the COPD and asthma category (Fig 1), in the US and Canada but not in France.
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Ficuar 1. Proportion of COPD

FIGURE 1. Proportion of COPD and asthma deaths attributed to bronchitis, emphysema, and asthma compared with chronic airways obstruction, US, Canada, and France, 1979 and 1983.

Age-adjusted death rates for COPD and asthma by sex in France from 1969 to 1983 for the broad age range 55 to 84 years are shown in Figure 2. For each cause, death rates have been adjusted to the age distribution of the French population of 1968, a census year. COPD and asthma mortality rates were relatively constant during 1969-1978. The marked increases between 1978 and 1979 coincide with beginning of the 9th revision, which introduced the separate tabu­lation of deaths from chronic airways obstruction NEC. The main respiratory cause of death (almost Уз) is bronchitis, especially in men. Death rates for bronchi­tis increased in men and women at the beginning of the study period. On the contrary, mortality from emphysema (for both sexes) and asthma (for men) decreased during the entire study period.

Table Death Rates (per 100,000 population) from COPD and Asthma Age Group 65-74, in the US, Canada, and France, 1969-1983


Bronchitis


Emphysema


Asthma


Years

490-491

492
CAO-NEC*

493


Total


US

1969

14.9

69.1

8.0

3.8

95.8

1970

14.4

68.7

13.3

3.5

99.9

1971

13.9

65.5

17.8

3.7

100.9

1972

15.1

65.2

23.0

3.8

107.1

1973

13.1

63.0

30.8

3.1

110.0

1974

12.0

55.6

38.7

3.2

109.5

1975

10.8

51.2

45.7

3.2

110.9

1976

10.2

47.0

54.3

3.4

114.9

1977

9.6

41.6

60.2

3.0

114.4

1978

9.3

38.7

70.8

3.0

121.8

1979

7.6

33.6

71.4

4.5

117.0

1980

7.6

33.5

83.1

4.9

129.1

1981

7.2

32.6

87.7

5.1

132.7

1982

6.5

30.0

89.8

4.9

131.2

1983

6.6

30.3


Canada

97.8

5.1

139.8

1974

37.9

38.7

26.6

7.3

110.6

1975

36.1

38.0

30.8

8.3

113.2

1976

36.7

34.4

40.6

5.3

117.0

1977

30.9

32.1

42.5

5.2

110.7

1978

32.9

34.9

47.7

6.1

121.7

1979

21.1

27.4

54.4

8.3

111.1

1980

19.7

28.4

54.1

7.4

109.6

1981

19.2

30.5

52.5

7.0

109.2

1982

14.7

26.5

67.5

8.5

117.2

1983

10.7

25.5


France

70.7

8.1

115.0

1969

18.5

12.4

12.2

43.0

1970

16.5

9.9

10.0

36.4

1971

18.1

11.7

11.2

41.0

1972

23.0

10.4

10.4

43.8

1973

23.8

9.5

10.8

44.0

1974

24.1

8.2

9.7

42.0

1975

24.5

9.4

9.4

43.3

1976

23.7

8.3

9.8

41.8

1977

21.4

7.8

9.1

38.3

1978

21.3

8.0

8.9

38.2

1979

18.8

6.3

24.9

8.4

58.4

1980

19.0

6.1

28.7

8.5

62.3

1981

18.3

6.3

29.9

9.3

63.8

1982

18.5

6.3

30.3

9.0

64.1

1983

18.0

5.4

32.0

7.4

62.7

Ficuax 2. Age-adjusted death rates

FIGURE 2. Age-adjusted death rates for COPD and asthma, ages 55-84, France, 1969-1983.

Trends in France by sex for the three age groups are shown in Figure 3. Mortality is noticeably higher in men than women. In each age group, the curves for men are at the same level as for women ten years older. The same sharp increase (as in Fig 2) due to revision in cause-of-death coding is observed between 1978 and 1979. Trends were flat prior to 1979, but slightly upward since then.
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FIGURE 3. Death rates for COPD

FIGURE 3. Death rates for COPD and asthma by age and sex, France, 1969 to 1983.

Age-sex specific death rates for COPD and asthma for the three countries, from 1979 to 1983, are presented in Figure 4. Male/female differentials in mortality are of similar magnitude among the three countries. However, with respect to trends, there are much steeper increases for women than men in the US and Canada so that the differentials are narrowing in those two countries, but not in France. The US and French death rates for COPD and asthma including mortality for the special ICD/8 code 519.3 for the US and the closest comparable ICD/8 code for France, (519.9), other diseases of the respiratory system, are shown in Figure 5. Even with inclusion of this code the US curves remain above those for France, espe­cially for women.

Table 3—Male/Female Ratios for COPD and Asthma for U.S. Canada and Prance 1969-1983

us


Canada


France


COPD*


Asthma$
.


COPD*


Asthma}:


COPDt


Asthma^

1969

5.13

1.00


55-64

years

Data not


available

7.76

1.76

1970

4.54

0.89

Data
not


available

8.21

2.35

1971

4.40

0.81

Data
not


available

7.32

1.69

1972

4.06

0.86

Data
not


available

6.26

1.92

1973

3.76

0.82

Data
not


available

5.90

2.08

1974

3.32

0.91

3.34

1.40

5.34

1.47

1975

3.09

0.91

4.10

1.15

6.21

1.36

1976

3.01

0.79

4.60

0.74

6.33

1.27

1977

2.80

0.93

3.66

0.89

6.91

1.10

1978

2.45

0.59

3.38

1.83

5.05

0.94

1979

2.44

0.92

3.02

0.97

4.55

1.17

1980

2.30

0.88

3.42

0.84

5.07

1.00

1981

2.20

0.90

2.99

1.01

5.38

1.09

1982

2.10

0.79

2.95

0.69

4.43

1.17

1983

2.10

0.79

2.73

0.83

4.82

0.98

1969

7.87

1.33


65-74

years

Data not


available

4.93

1.68

1970

7.06

1.12

Data
not


available

5.40

1.96

1971

4.76

1.15

Data
not


available

5.57

1.90

1972

5.93

1.17

Data
not


available

5.27

1.95

1973

5.63

1.21

Data
not


available

5.63

1.85

1974

5.21

1.13

7.11

1.94

5.31

1.77

1975

4.96

1.24

5.71

1.10

5.81

1.79

1976

4.62

1.19

5.01

2.48

5.79

1.76

1977

4.21

1.03

4.79

1.48

5.47

1.30

1978

3.85

1.00

4.32

1.50

6.20

1.55

1979

3.70

1.17

4.57

1.19

4.80

1.50

1980

3.26

1.25

4.56

0.97

5.02

1.33

1981

3.05

0.94

4.29

1.40

5.10

1.25

1982

2.79

0.96

4.09

0.94

5.05

1.46

1983

2.58

0.98

3.58

0.96

4.74

0.79

1969

7.42

1.66


75-84

years

Data not


available

3.63

1.78

1970

7.76

1.30

Data
not


available

3.50

1.74

1971

7.09

1.17

Data
not


available

4.10

1.69

1972

7.30

1.25

Data
not


available

4.38

1.66

1973

6.89

1.18

Data
not


available

4.23

1.47

1974

6.46

1.34

7.33

1.77

4.18

1.78

1975

6.55

1.07

6.90

2.39

4.52

1.45

1976

5.89

1.14

6.30

0.88

4.53

1.85

1977

5.81

1.02

6.09

1.39

4.50

1.64

1978

5.31

1.09

6.17

1.13

4.38

1.36

1979

5.10

1.21

6.56

1.57

4.45

1.26

1980

4.64

1.47

6.05

1.87

4.03

1.29

1981

4.25

1.16

5.90

1.54

4.29

1.48

1982

4.11

1.10

5.42

1.27

4.22

1.35

1983

3.83

1.05

5.55

1.58

4.73

1.21

Ficunu 4. Death rates for COPD

FIGURE 4. Death rates for COPD and asthma by age and sex, US, Canada, France, 1979-1983.

The male/female ratios of COPD and asthma death rates separately by age group in the US, Canada and France are presented in Table 3. For asthma, the ratios are nearly constant, but higher in France than in the US, especially before 1979. For COPD, the sex ratios rise with age in the US and Canada, but not in France. In the US and Canada, the sex ratios were higher in the earlier years. For the three countries, the sex differences at each age are much smaller for asthma than COPD, especially in recent years. These data suggest that some deaths which are attributed to asthma in French men would be attributed to COPD in the US.
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Category: Diseases / Tags: asthma, Mortality, Pulmonary Diseases

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