A16-02 Life Expectancy in Chronic Obstructive Pulmonary Disease

Abstract Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of death and age-standardized COPD mortality has increased substantially over the past few decades. Robust estimates of life expectancy and years of life loss (YLL) from COPD, which are important to patient care and policy decisions, are lacking. We aimed to determine whether COPD results in lower life expectancy, and whether the years of life lost are associated with disease severity. Methods The NHLBI Pooled Cohorts Study harmonized and pooled data from eight US general population cohorts. Participants aged 17-98 years were enrolled from 1983-2011 and followed longitudinally through 2020. Presence of COPD was was defined by pre-bronchodilator ratio of FEV1/FVC 0.70, and disease stages per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. We used a parametric proportional hazards model with a Gompertz baseline hazard function to estimate survival by GOLD stage from the time of initial spirometry. The multivariable hazards function was used to estimate life expectancy, adjusting for demographics, educational attainment, BMI, smoking status, pack-years of smoking, diabetes, hypertension, and hypercholesterolemia. Years of life lost (YLL) was calculated in comparison with individuals with no airflow obstruction. Results Of 45,886 participants (mean age 52.4 yrs, 56.3% female, 59.1% non-Hispanic white), 13,869 (30.2%) died over a median follow-up of 15.2 years. COPD was present in 8,058 (17.6%). Compared to those without COPD, average life expectancy was lower with increasing disease severity: 23.0 (95%CI 22.6-23.4) for GOLD 1, 18.9 (95%CI 18.5-19.3) for GOLD 2, 13.7 (95%CI 12.9-14.5) for GOLD 3, and 11.0 (95%CI 9.2-12.9) years for GOLD 4 (Figure). Years of life lost were 0.7(95%CI 0.3-1.1), 2.6(95%CI 2.2-3.0), 5.1(95%CI 4.4-5.7), and 7.1(95%CI 5.2-9.0) years for GOLD stages 1 through 4, respectively. Comparable decreases were noted for COPD in those who never smoked versus ever smoked. YLL for GOLD stages 2-4 were similar or greater than the YLL lost for hypertension (2.7, 95%CI 2.4-3.0), diabetes (4.1, 95%CI 3.7-4.4), obesity (0.5, 95%CI 0.1-0.9), and cigarette smoking (5.5, 95%CI 5.1-5.9). Conclusions COPD is associated with lower life expectancy, including in adults who never smoked. The years of life lost with clinically significant COPD, GOLD stages 2 and above, was comparable to those noted with hypertension and diabetes. This abstract is funded by: SPB is supported by NIH R01HL151421 and UH3HL155806. YS is supported by NIH R21HL156228 and RF1AG081413. PPB is supported by NIH R21HL165405 and R21HL15622. ECO is supported by NIH R01HL155576, R01HL157634, R21HL165405, R21 HL129924, and R21HL15622. The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004, 75N92022D00005). The authors thank the staff and participants of the ARIC study for their important contributions. This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, 75N92021D00006, and grants U01HL080295, U01HL130114, and R01HL172803 from the National Heart, Lung, and Blood Institute (NHLBI), with additio