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Original Article
Changing causes of death for patients with chronic respiratory disease in England, 2005-2015
  1. Alicia V Gayle1,2,
  2. Eleanor L Axson1,
  3. Chloe I Bloom1,
  4. Vidya Navaratnam3,
  5. Jennifer K Quint1
  1. 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
  2. 2 Market Access, Boehringer Ingelheim Ltd, Bracknell, UK
  3. 3 Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to Alicia V Gayle, National Heart and Lung Institute, Imperial College London, London SW3 6LR, UK; alicia.gayle14{at}


Background Chronic respiratory diseases (CRD) are common, are 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 patients with CRD.

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, COPD and interstitial lung diseases (ILD)) during 2005–2015 in England.

Results We identified 558 888 patients with CRD (451 830 asthma, 137 709 COPD, 19 374 bronchiectasis, 10 745 ILD). The age-standardised mortality rate of patients with CRD was 1607 per 100 000 persons (asthma=856, COPD=1503, ILD=2609, bronchiectasis=1463). CRD mortality was overall 54% higher than the general population. A third of patients with CRD 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 Patients with CRD continue to experience substantial morbidity and mortality due to respiratory diseases. Disease-modifying intervention strategies are needed to improve outcomes for patients with CRD.

  • copd epidemiology
  • asthma epidemiology
  • bronchiectasis
  • clinical epidemiology

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  • AVG and ELA contributed equally.

  • Contributors ELA defined the cohort. AVG determined cause of death. AVG and ELA performed the statistical analyses and drafted the original manuscript. CIB, VN and JKQ reviewed the analyses. JKQ designed the study. All authors took part in the production of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AVG is supported by an educational grant and is an employee of Boehringer Ingelheim Ltd. JKQ’s research group has received funding from MRC, Wellcome Trust, BLF, GSK, Insmed, AZ, Bayer and BI for other projects, none of which relate to this work. JKQ has received funds from AZ, GSK, Chiesi, Teva and BI for Advisory board participation or travel. VN is an NIHR clinical lecturer.

  • Ethics approval The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number 17_086R) and the approved protocol was made available to the journal and reviewers during peer review. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority (HRA) Research Ethics Committee (East Midlands – Derby, REC reference number 05/MRE04/87). Following ethics approval by ISAC, the study population was expanded to include all adults, 18 years of age and older, to be in line with most studies in this research area; and IPF was expanded to ILD, to better understand the burden of CRD in the UK. These were considered minor amendments and did not require further ISAC approval. Linked pseudonymised data were provided for this study by CPRD. Data are linked by NHS Digital, the statutory trusted third party for linking data, using identifiable data held only by NHS Digital. Select general practices consent to this process at a practice level with individual patients having the right to opt out.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Data are available on request from the CPRD. Their provision requires the purchase of a license, and our license does not permit us to make them publicly available to all. We used data from the version collected in October 2017 and have clearly specified the data selected in our Methods section. To allow identical data to be obtained by others, via the purchase of a license, we will provide the code lists on request. Licences are available from the CPRD ( The Clinical Practice Research Datalink Group, The Medicines and Healthcare products Regulatory Agency, 5th Floor, 151 Buckingham Palace Road, Victoria, London SW1 W 9SZ.

  • Patient consent for publication Not required.

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