Changing causes of death for patients with chronic respiratory disease in England, 2005-2015

Background: Chronic respiratory diseases (CRD) are common, increasing in prevalence, and cause significant morbidity and mortality worldwide. However, we have limited knowledge on causes of death of patients with CRD in the general population. Objective: We evaluated mortality rates and causes of death over time in CRD patients.Methods: We used linked primary care and mortality data to determine mortality rates and the most common causes of death in people with CRD (including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung diseases (ILD)) during 2005-2015 in England. Results: We identified 558,888 CRD patients (451,830 asthma, 137,709 COPD, 19,374 bronchiectasis, 10,745 ILD). The age-standardised mortality rate of patients with CRD was 1,607 per 100,000 persons (asthma=856, COPD=1,503, ILD=2,609, bronchiectasis=1,463). CRD mortality was overall 54% higher than the general population. One third of CRD patients died from respiratory-related causes. Respiratory-related mortality was constant, while cardiovascular-related mortality decreased significantly over time. COPD accounted for the majority of respiratory-related deaths (66% overall) in all patient groups except ILD. Conclusions: CRD patients continue to experience substantial morbidity and mortality due to respiratory diseases. Disease-modifying intervention strategies are needed to improve outcomes for patients with CRD.