Global Initiative for Chronic Obstructive Lung Disease group E status prior to COPD- or cardiovascular-related death: a nationwide study

Background COPD is the third leading cause of death worldwide. However, little is known about the characteristics of patients who die from COPD. The aim of this study was to determine the relationship between change or persistence in Global Initiative for Chronic Obstructive Lung Disease group E (GOLD-E) status over time and COPD- and cardiovascular (CV)-related death. Methods Patients with COPD were identified by International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in the French national health insurance database. Patients who died from COPD or CV diseases between 1 January 2017 and 31 December 2022 were matched with living COPD patients. We performed a case–control analysis to compare the impact of the change in GOLD-E status between two periods: 13–24 months (period 2 (2026)) and 0–12 months (period 1 (2025)) prior to death or the index date. Results A total of 500 673 COPD patients died during the study period. Of these, 67 250 died from COPD and 41 585 from CV events. Of the patients whose deaths were COPD related, the proportion of patients with GOLD-E 2026 status increased between the two periods (58.3% versus 79.2%), but decreased in their matched living controls (58.3% versus 36.9%). Of the patients with GOLD-E 2026 status during period 2, becoming and remaining GOLD-E 2026 within their final 12 months was associated with COPD-related death (odds ratios 5.40 (95% CI 5.03–5.79) and 4.16 (95% CI 3.87–4.48), respectively; p<0.0001). Interpretation These data demonstrate that being GOLD-E for 2 years in a row is associated with a high risk of COPD-related death, of the same magnitude as being GOLD-E for 1 year.