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Supplementary Information Changing causes of death for chronic respiratory disease patients in England, 2005-2015Alicia V Gayle, Eleanor L Axson, Chloe I Bloom, Vidya Navaratnam, Jennifer K QuintFigure 1. Flow chart of patient inclusion. CRD includes asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Disease component numbers do not sum to total numbers as patients were able to be part of multiple disease groups.Figure 2. Age-standardised mortality (ASM) per 100,000 population compared to the general population, 2005-2015. Presented for all patients with: asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Rates compared to the general population. Groups differentiated as ‘only’ refer to those patients with that respiratory disease and no other respiratory disease comorbidities. Disease group presented are mutually exclusive. pop = population.Figure 3. Leading Causes of Death among CRD patients by disease. Presented as percentages of all deaths per year for the overall CRD and by individual disease; including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioural disorders) and G (diseases of the nervous system) have been combined. ‘Other’ refers to causes of death categorized in all ICD-10 chapters outside of C, D00-48, F, G, I, J, and K.Figure 4. Trends in leading causes of death in the chronic respiratory disease (CRD) population, 2005-2015. Presented as % of all deaths per year for the overall CRD population; including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioural disorders) and G (diseases of the nervous system) have been combined. ‘Other’ refers to causes of death categorized in all ICD-10 chapters outside of C, D00-48, F, G, I, J, and K. Significant p-values (α < 0.05) from Chi-squared test for trend are shown.MethodsCPRD MedcodesCOPD codes additional to validated list104608, 104710, 104985, 105457, 106637, 65733, 67040, 60188, 46578, 16410Validated list published as: Quint JK, Mullerova H, DiSantostefano RL, et al. Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD). BMJ Open 2014; 4(7): e005540.?Base CRD Cohort n (%)Base Asthma Cohort n (%)Base Bronchiectasis Cohort n (%)Base COPD Cohort n (%)Base ILD Cohort n (%)Number of Patients558,888451,83019,374137,70910,745?Female309,191(55.3)260,484(57.7)11,083(57.2)65,060(47.2)4,056(37.8)?Age at Start, years (mean, SD) Males48.8 ± 21.042.4 ± 18.664.2 ± 15.869.0 ± 12.169.8 ± 13.4 Females48.1 ± 21.043.8 ± 19.364.7 ± 16.069.2 ± 12.969.4 ± 15.3?Age Groups at Start 18-24 years91,501 (16.4)91,166 (20.2)448 (2.31)0 (0.00)63 (0.59) 25-34 years88,386 (15.8)87,856 (19.4)634 (3.27)294 (0.21)179 (1.67) 35-44 years83,670 (15.0)81,212 (18.0)1,187 (6.13)4,060 (2.95)459 (4.27) 45-54 years70,175 (12.6)62,091 (13.7)1,999 (10.3)13,188 (9.58)822 (7.65) 55-64 years75,355 (13.5)54,006 (12.0)4,422 (22.8)30,660 (22.3)1,732 (16.1) 65-74 years72,044 (12.90)41,726 (9.23)5,170 (26.7)39,898 (29.0)2,935 (27.3) 75-84 years55,731 (10.0)25,679 (5.68)3,988 (20.6)35,129 (25.5)3,289 (30.6) 85+ years22,026 (3.94)8,094 (1.79)1,526 (7.88)14,480 (10.5)1,266 (11.8)?Smoking Status Never Smoker/Not Recorded260,246 (46.6)234,675 (51.9)9,882 (51.0)26,598 (19.3)4,468 (41.6) Current Smoker134,947 (24.2)100,901 (22.3)2,198 (11.4)47,472 (34.5)1,234 (11.5) Former Smoker163,695 (29.3)116,254 (25.7)7,294 (37.7)63,639 (46.2)5,043 (46.9)?Body Mass Index (kg/m?) Underweight (< 18.5)18,367 (3.78)12,716 (3.22)1,062 (6.25)6,522 (5.39)283 (3.07) Healthy Weight (18.5-24.9)181,412 (37.3)146,872 (37.2)6,973 (41.0)42,639 (35.2)3,062 (33.2) Overweight (25.0-29.9)154,578 (31.8)125,226 (31.7)5,570 (32.8)39,474 (32.6)3,518 (38.2) Obese (>= 30)132,148 (27.2)110,264 (27.9)3,397 (20.0)32,458 (26.8)2,356 (25.6)??Diagnosis of Asthma451,830 (80.8)~6,539 (33.8)46,653 (33.9)1,580 (14.7)Diagnosis of Bronchiectasis19,374 (3.47)6,539 (1.45)~6,625 (4.81)744 (6.92)Diagnosis of COPD137,709 (24.6)46,653(10.3)6,625 (34.2)~2,635 (24.5)Diagnosis of ILD10,745 (1.92)1,580 (0.35)744 (3.84)2,635 (1.91)~ Diagnosis IPF1,380 (0.25)141 (0.03)81 (0.42)307 (0.22)1,380 (12.8) Diagnosis Pneumoconiosis1,931 (0.35)312 (0.07)87 (0.45)670 (0.49)1,931 (18.0) Diagnosis Sarcoidosis1,271 (0.23)201 (0.04)48 (0.25)105 (0.08)1,271 (11.8)?Index of Multiple Deprivation 1- Most Deprived111,370 (19.9)94,134 (20.9)4,794 (24.8)20,358 (14.8)2,265 (21.1) 2-116,210 (20.8)95,381 (21.1)4,541 (23.5)25,798 (18.8)2,405 (22.4) 3-115,460 (20.7)93,627 (20.7)3,803 (19.6)27,888 (20.3)2,314 (21.6) 4-111,209 (19.9)88,367 (19.6)3,162 (16.3)30,623 (22.3)1,965 (18.3) 5- Least Deprived104,161 (18.7)79,937 (17.7)3,067 (15.8)32,923 (23.9)1,790 (16.7)Number of Patient Deaths75,789 (13.6)27,656 (6.12)5,446 (28.1)54,320 (39.4)5,249 (48.9)S1. Descriptive statistics of the Chronic Respiratory Disease (CRD) patient cohort.Age (years)SexNever Smoker/Not RecordedFormer SmokerCurrent Smoker20-24F27 (23-28)0 (0-0)127 (123-131)M31 (30-32)174 (160-188)47 (45-49)25-34F26 (23-26)26 (25-26)204 (199-210)M24 (23-24)85 (81-88)256 (249-263)35-44F115 (112-117)59 (57-60)553 (539-567)M201 (197-205)278 (269-287)304 (296-312)45-54F238 (234-242)233 (227-240)729 (711-747)M367 (359-374)537 (521-553)1,256 (1,220-1,292)55-64F558 (548-568)1,043 (1,019-1,068)2,191 (2,136-2,247)M860 (839-880)1,325 (1,294-1,357)2,872 (2,793-2,952)65-74F1,731 (1,696-1,766)2,604 (2,549-2,660)4,849 (4,709-4,990)M2,871 (2,792-2,951)3,669 (3,597-3,742)6,842 (6,640-7,044)75-84F5,094 (4,980-5,208)7,459 (7,286-7,631)13,601 (13,050-14,153)M7,359 (7,117-7,600)9,217 (9,021-9,413)15,197 (14,519-15,875)85+F17,947 (17,381-18,512)17,465 (16,834-18,096)18,507 (17,106-19,909)M12,697 (12,122-13,252)21,161 (20,399-21,923)17,384 (16,204-18,745)S2. Crude mortality rates stratified by age, sex, and smoking status in 2010. Mortality (95% CI) per 100,000 population. Presented for males (M) and females (F) by age group and smoking status.?CRD CohortAsthmaBronchiectasisCOPDILDBody Mass Index (kg/m?)Underweight (< 18.5)6,724 (6,561-6,886)2,702 (2,624-2,780)12,984 (11,769-14,199)15,398 (14,774-16,022)21,250 (16,593-25,907)Healthy Weight (18.5-24.9)2,719 (2,701-2,737)1,138 (1,129-1,146)4,379 (4,244-4,514)7,830 (7,724-7,936)11,944 (11,272-12,616)Overweight (25-29.9)2,398 (2,381-2,414)1,106 (1,097-1,114)3,449 (3,334-3,564)5,594 (5,520-5,669)11,823 (11,227-12,419)Obese (>= 30)2,057 (2,042-2,072)1,045 (1,037-1,053)2,290 (2,193-2,387)4,945 (4,873-5,017)8,209 (7,718-8,700)Index of Multiple DeprivationI - Most Deprived2,128 (2,110-2,145)918 (910-926)4,203 (4,049-4,356)6,925 (6,793-7,058)10,554 (9,885-11,222)II2,572 (2,551-2,593)1,133 (1,123-1,143)3,873 (3,727-4,019)6,999 (6,880-7,119)10,061 (9,432-10,690)III2,576 (2,555-2,598)1,160 (1,149-1,170)4,269 (4,092-4,445)6,732 (6,621-6,842)12,128 (11,352-12,903)IV2,916 (2,891-2,941)1,241 (1,229-1,253)4,608 (4,392-3,823)7,007 (6,896-7,117)12,798 (11,909-13,687)V - Least Deprived3,212 (3,183-3,240)1,443 (1,429-1,458)5,226 (4,980-5,473)6,775 (6,673-6,877)10,544 (9,803-11,305)S3. Crude mortality rates stratified by BMI and IMD in 2010. Presented for overall CRD cohort and sub-cohorts. Data are presented as mortality (95% CI), per 100,000 population. Rates have been calculated using a mid-year population estimate for 2010. BMI = body mass index (kg/m2); IMD = Index of Multiple Deprivation; CRD = chronic respiratory disease including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD).NN DeathsCrude Mortality RateASMRGeneral Population57,885,4135,477,2901,178 (1,177 – 1,178)867 (867 - 868)CRD Patients558,88875,7893,030 (3,022 - 3,038)1,607 (1,603 - 1,611)Asthma only400,78315,153808 (805 - 810)787 (784 - 789)Bronchiectasis only8,7892,1594,692 (4,594 - 4,790)1,559 (1,527 - 1,592)COPD only85,63239,46811,032 (10,958 -11,106)3,106 (3,085 - 3,126)ILD only6,8313,31212,698 (12,397 - 12,999)3,755 (3,666 - 3,844)S4. Mortality rates stratified by CRD, 2004 - 2015. Presented for overall CRD cohort and sub-cohorts without comorbid respiratory diseases. Data are presented as mortality (95% CI), per 100,000 population. Rates have been calculated by averaging over mid-year population estimates for each year. Age standardised mortality rate (ASMR). CRD = chronic respiratory disease including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD).?Chapter (ICD-10)N% of all deathsCRDAsthmaBronchiectasisCOPDILDDiseases of the respiratory system(J00-J99)24,36332%24%41%36%49%Diseases of the circulatory system(I00-I99)19,41026%28%21%25%20%Neoplasms(C00-D48)18,34124%27%18%23%17%Diseases of the digestive system(K00-K93)3,2284%5%4%4%3%Mental and behavioural disorders(F00-F99)3,1724%4%5%4%3%External causes of morbidity(V01-Y98)1,7572%4%2%2%1%Diseases of the nervous system(G00-G99)1,5072%2%3%2%1%Diseases of the genitourinary system(N00-N99)1,2042%2%2%2%1%Certain infectious and parasitic diseases(A00-B99)8391%1%1%1%1%Endocrine, nutritional and metabolic diseases(E00-E90)7741%1%1%1%1%Diseases of the musculoskeletal system and connective tissue(M00-M99)5621%1%1%1%2%Diseases of the skin and subcutaneous tissue(L00-L99)2360%0%0%0%0%Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)1620%0%1%0%1%Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified(R00-R99)1530%0%0%0%0%Congenital malformations, deformations and chromosomal abnormalities(Q00-Q99)710%0%0%0%0%Provisional assignment of new diseases of uncertain aetiology or emergency use(U00-U49)60%0%0%0%0%Diseases of the eye and adnexa, the ear and mastoid process(H00-H95)< 50%0%0%0%0%Pregnancy, childbirth and the puerperium(O00-O99)< 50%0%0%0%0%Total75,789100%100%100%100%100%S5. Causes of death by ICD-10 chapter. Using ONS derived cause of death. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).CRDAsthmaBronchiectasisCOPDILDChapter (ICD-10)N% all deaths% chapterN% all deaths%chapterN% all deaths% chapterN% all deaths% chapterN% of all deaths% chapterDiseases of the Respiratory System (J00-J99)24,36332%100%2,14814%32%61629%100%13,78435%70%1,59548%62%COPD16,04321%66%6354%9%1085%18%11,10228%57%903%3%Pneumonia3,2304%13%7765%12%1366%22%1,5594%8%1344%5%Idiopathic pulmonary fibrosis1,8122%7%420%1%271%4%1360%1%1,11234%43%Bronchiectasis8531%4%220%0%28013%45%1010%1%90%0%Asthma5921%2%3382%5%60%1%1120%1%<50%0%Lung disease due to external agents5511%2%831%1%171%3%2471%1%672%3%Influenza120%0%50%0%00%0%<50%0%00%0%Other1,2702%5%2472%4%422%7%5271%3%1836%7%Diseases of the Circulatory System (I00-I99)19,41026%100%4,67031%60%54425%100%9,78325%73%70021%100%Ischaemic Heart Disease9,56513%49%2,17114%28%24511%45%4,83412%36%38512%55%Cerebrovascular Disease4,0355%21%1,0337%13%1356%25%2,0385%15%1304%19%Heart Failure9711%5%2302%3%291%5%4961%4%361%5%Other4,8396%25%1,2368%16%1356%25%2,4156%18%1494%21%Neoplasms (C00-D48)18,34124%100%4,45629%60%44321%100%9,39324%74%53916%100%Lung Cancer6,8579%37%8335%11%824%19%4,34611%34%1906%22%Prostate Cancer9791%5%2332%3%251%6%5011%4%331%4%Breast Cancer8641%5%4033%5%321%7%2681%2%261%3%Pancreatic Cancer7741%4%2532%3%251%6%3291%3%201%2%Bladder Cancer5621%3%1071%1%171%4%3121%2%160%2%Pleural Mesothelioma300%0%100%0%<50%0%130%0%<50%0%Other8,30511%45%2,62717%35%26212%59%9,39324%74%2548%29%Mental and behavioural disorders and Diseases of the nervous system(F00-G99)4,6796%100%1,1908%100%25812%100%2,5246%100%1484%100%Diseases of the digestive system (K00-K93)3,2284%100%9106%100%894%100%1,4794%100%893%100%TOTAL70,02192%?13,37488%?1,95090%?36,96394%?3,07193%?S6. Causes of death by underlying CRD for patients without comorbid CRD. Presented as counts, % of all deaths, and % of deaths within ICD-10 chapter. Values rounded to nearest whole number. CRD = chronic respiratory disease including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioral disorders) and G (diseases of the nervous system) have been combined.?Chapter (ICD-10)N% of all deathsCRDAsthmaBronchiectasisCOPDILDDiseases of the respiratory system (J00-J99)30,52340%26%41%43%54%Diseases of the circulatory system (I00-I99)16,54622%26%20%21%20%Neoplasms (C00-D48)14,40419%24%15%19%12%Mental and behavioural disorders (F00-F99)3,3494%5%8%5%4%Certain infectious and parasitic diseases (A00-B99)2,9414%4%4%4%4%Diseases of the digestive system (K00-K93)2,3933%4%3%3%3%Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)1,6872%3%3%2%2%Diseases of the genitourinary system (N00-N99)1,4382%2%2%2%1%External causes of morbidity(V01-Y98)1,3352%4%2%1%1%Diseases of the nervous system (G00-G99)7851%2%2%1%1%Endocrine, nutritional and metabolic diseases (E00-E90)1750%0%0%0%0%Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)1280%0%0%0%0%Diseases of the musculoskeletal system and connective tissue (M00-M99)370%0%0%0%0%Diseases of the skin and subcutaneous tissue(L00-L99)360%0%0%0%0%Provisional assignment of new diseases of uncertain aetiology or emergency use (U00-U49)60%0%0%0%0%Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)50%0%0%0%0%Pregnancy, childbirth and the puerperium (O00-O99)<50%0%0%0%0%Diseases of the eye and adnexa, the ear and mastoid process (H00-H95)00%0%0%0%0%Total75,789100%100%100%100%100%S7. Causes of death by chapter. Using the ICD-10 code in first position on death certificate.S8. Leading causes of death in each chronic respiratory disease population, 2005-2014. Presented as % of all deaths per year for asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Significant p-values (α < 0.05) from Cochran-Armitage test for trend are shown.S9. Trends in leading causes of death in the chronic respiratory disease (CRD) population by age, 2005-2015. Presented as % of all deaths per year for the overall CRD population; including asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). ICD-10 chapters F (mental and behavioural disorders) and G (diseases of the nervous system) have been combined. ‘Other’ refers to causes of death categorized in all ICD-10 chapters outside of C, D00-48, F, G, I, J, and K. ................
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