Prevalence of Chronic Obstructive Pulmonary Disease in England from 2000 to 2019

Abstract

Background

There is considerable variation in reported chronic obstructive pulmonary disease (COPD) prevalence internationally, partly due to differing definitions in use. Accurate estimates of disease prevalence are important for allocation of health-care resources, yet UK estimates of COPD prevalence have not been updated for a decade. We calculated yearly COPD prevalence in England between 2000 and 2019 using different definitions of COPD.

Methods

We used routinely collected primary care electronic healthcare record (EHR) data from the Clinical Practice Research Datalink (CPRD) Aurum database linked with secondary care data from the Hospital Episode Statistics (HES) Admitted Patient Care (APC) database. Mid-year point prevalence was calculated yearly from 2000 to 2019 in English adults aged ≥40 years using 5 definitions: (i) validated COPD, (ii) Quality and Outcomes Framework (QOF) COPD, (iii) COPD symptoms, inhaler prescription, and no asthma diagnosis, (iv) hospitalisation with COPD as any diagnosis, (v) hospitalisation with COPD as primary or secondary diagnosis. Prevalence was further stratified by gender, age group, and region.

Results

A total of 12,745,793 people were included over the 20-year period. Annual cohort sizes ranged from 4,373,538 in 2000 to 6,159,496 in 2019. Estimates of COPD prevalence increased every year from 2000 and the difference in estimated prevalence between the validated and QOF definitions has grown over time. In 2019, a COPD prevalence of 4.9% was found using validated events in either primary or secondary care (definition 1 or definition 5). Additionally, including potentially undiagnosed cases (definition 3) in the COPD definition produced an increased prevalence of 6.7%.

Conclusion

Common definitions of COPD (eg, QOF codes), may underestimate the true prevalence. The extent of this underestimate has increased over time and could lead to under-allocation of resources where need is estimated based on these definitions. Standardisation of COPD coding in routine EHRs and metrics such as spirometry is key to accurate disease monitoring.

Keywords:

• prevalence
• England
• chronic obstructive pulmonary disease
• COPD
• clinical practice research datalink
• CPRD

Acknowledgments

This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the author/s alone. Hospital Episode Statistics (HES) data, copyright © 2023, re-used with the permission of The Health & Social Care Information Centre. All rights reserved.

Disclosure

Dr Philip W Stone reports grants from Asthma + Lung UK, during the conduct of the study; grants from Royal College of Physicians and Gilead Sciences, outside the submitted work. Mr Andrew Ellis, Mrs Rebecca Coaker, and Mr Michael Osen report grants, non-financial support from Amgen Ltd, AstraZeneca, Boehringer Ingelheim, Copley Scientific Limited, Chiesi Ltd, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson Ltd, Merck Sharpe and Dohme Ltd (MSD), Medtronic Limited, Novartis Pharmaceuticals UK Ltd, PARI Medical Ltd, Pfizer, Sanofi, Seqirus, Takeda Pharma, Trudell Medical, Verona Pharma, Vitalograph; non-financial support from Air Liquide Healthcare, Bristol-Myers Squibb, Circassia, My mHealth, Nowus Healthcare, Roche, Spink (BEAMA), Association of the British Pharmaceutical Industry, during the conduct of the study; grants, non-financial support from Amgen Ltd, AstraZeneca, Boehringer Ingelheim, Copley Scientific Limited, Chiesi Ltd, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson Ltd, Merck Sharpe and Dohme, Medtronic Limited, Novartis Pharmaceuticals, PARI Medical Ltd, Pfizer, Sanofi, Seqirus, Takeda Pharma, Trudell Medical, Verona Pharma, Vitalograph; non-financial support from Air Liquide Healthcare, Bristol-Myers Squibb, Circassia, My mHealth, Nowus Healthcare, Roche, Spink (BEAMA), Association of the British Pharmaceutical Industry, outside the submitted work. Professor Jennifer K Quint reports grants from Taskforce through A+L UK, during the conduct of the study; grants and personal fees from MRC, HDR UK, AZ, BI, Insmed, Gilead, GSK, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

Asthma + Lung UK provided funding to Imperial College London on behalf of the Taskforce for Lung Health to undertake this work.