Coded Cause of Death and Timing of COPD Diagnosis

Figures & data

Table 1 Characteristics of patients who died with diagnosis of COPD (N = 26,357)

	Preexistent COPD (N = 7,729)	Recent COPD (N = 18,628)	p-value
Age at death [mean, SD]	73.9 (9.1)	73.1 (10.2)	<. 0001
Ethnicity [n, %]			<. 0001
White	5,508 (71.3)	13,114 (70.4)
Asian	8 (0.1)	53 (0.3)
African American	649 (8.4)	2,163 (11.6)
Native American	17 (0.2)	47 (0.3)
Unknown	1,547 (20.0)	3,251 (17.4)

Table 2 Proportional mortality ratios for underlying causes of death comparing preexistent COPD, recent COPD, and US general population

					Proportional Mortality Ratios (95% CI)
ICD-10 Code	Underlying cause of death, description	Preexistent COPD [% cause of death] N = 7,729	Recent COPD [% cause of death] N = 18,628	General Population [% cause of death]	Preexistent: recent	Recent: general population	Preexistent: general population
J449	COPD, unspecified	20.0%	10.0%^‡	4.5%	2.00 (1.88, 2.13)	2.21 (2.11, 2.31)	4.41 (4.22, 4.62)
C349	Lung cancer, unspecified	13.9%	15.5%^†	8.4%	0.89 (0.84, 0.95)	1.86 (1.80, 1.92)	1.66 (1.57, 1.75)
I251	Atherosclerotic heart disease	8.1%	9.1%^†	10.0%	0.89 (0.81, 0.97)	0.91 (0.87, 0.96)	0.81 (0.75, 0.88)
I219	Acute myocardial infarction, unspecified	7.1%	7.6%	9.1%	0.94 (0.86, 1.03)	0.83 (0.79, 0.87)	0.78 (0.72, 0.85)
J439	Emphysema, unspecified	3.0%	1.4%^‡	0.8%	2.20 (1.85, 2.63)	1.67 (1.48, 1.89)	3.68 (3.24, 4.18)
I250	Atherosclerotic cardiovascular disease	2.6%	2.7%	3.3%	0.96 (0.82, 1.13)	0.81 (0.75, 0.89)	0.78 (0.68, 0.90)
I500	Congestive heart failure	2.4%	2.3%	1.8%	1.04 (0.87, 1.23)	1.24 (1.12, 1.36)	1.28 (1.11, 1.48)
J189	Pneumonia, unspecified	1.7%	1.8%	2.2%	0.95 (0.78, 1.15)	0.83 (0.75, 0.92)	0.79 (0.66, 0.93)
C61	Prostate cancer	1.5%	1.9%	2.9%	0.80 (0.65, 0.98)	0.63 (0.57, 0.70)	0.51 (0.42, 0.61)
I64	Stroke, not specified as hemorrhage/infarction	1.5%	1.7%	3.1%	0.86 (0.70, 1.06)	0.56 (0.50, 0.62)	0.48 (0.40, 0.58)
A419	Septicemia, unspecified	1.2%	1.4%	1.1%	0.88 (0.70, 1.11)	1.25 (1.11, 1.41)	1.10 (0.90, 1.35)
C189	Colon cancer, unspecified	1.1%	1.1%	2.1%	1.03 (0.80, 1.32)	0.52 (0.45, 0.60)	0.53 (0.43, 0.66)
C80	Cancer, site unspecified	1.0%	1.4%	1.2%	0.77 (0.60, 0.98)	1.12 (0.99, 1.26)	0.85 (0.69, 1.06)
E149	Unspecified diabetes mellitus without complications	0.9%	1.5%^‡	1.7%	0.61 (0.47, 0.79)	0.86 (0.76, 0.96)	0.52 (0.41, 0.66)
J841	Other interstitial pulmonary diseases with fibrosis	0.9%	1.2%	0.5%	0.72 (0.55, 0.94)	2.64 (2.32, 3.00)	1.90 (1.50, 2.40)
I429	Cardiomyopathy, unspecified	0.9%	0.9%	1.0%	1.01 (0.77, 1.33)	0.96 (0.83, 1.11)	0.97 (0.77, 1.22)
I255	Ischemic cardiomyopathy	0.8%	0.7%	0.7%	1.11 (0.81, 1.51)	0.97 (0.82, 1.16)	1.08 (0.84, 1.40)
J448	COPD, other specified	0.8%	0.3%^‡	0.2%	2.50 (1.73, 3.60)	1.74 (1.34, 2.27)	4.36 (3.37, 5.63)
N19	Renal failure, unspecified	0.7%	0.8%	0.7%	0.78 (0.57, 1.07)	1.13 (0.97, 1.33)	0.89 (0.68, 1.17)
I119	Hypertensive heart disease without CHF	0.7%	0.6%	0.7%	1.01 (0.73, 1.41)	0.97 (0.81, 1.16)	0.98 (0.75, 1.30)

Significant difference between preexistent and recent COPD groups: * p-value < 0.05; ^† p-value < 0.01; ^‡ p-value < 0.001.

Table 3 Primary-coded cause of death, preexistent and recent COPD

Cause of death ICD-10 Code	Description	Preexistent COPD [% cause of death] N = 7,729	Recent COPD [% cause of death] N = 18,628	PMR (Preexistent recent) (95% CI)
C349	Lung/bronchial cancer, unspecified	14.7%	16.1%	0.91 (0.86, 0.97)^†
J449	COPD, unspecified	7.0%	2.8%	2.51 (2.23, 2.82)^‡
I251	Atherosclerotic heart disease	6.7%	7.0%	0.97 (0.88, 1.07)
I219	Acute myocardial infarction, unspecified	6.0%	5.9%	1.01 (0.91, 1.13)
A419	Septicemia, unspecified	5.5%	5.8%	0.96 (0.86, 1.07)
E149	Diabetes mellitus, no complications	3.7%	4.8%	0.78 (0.69, 0.89)^‡
I469	Cardiac arrest, unspecified	3.5%	2.7%	1.31 (1.13, 1.52)^‡
J189	Pneumonia, unspecified	3.0%	1.9%	1.54 (1.31, 1.82)^‡
I500	Congestive heart failure	2.9%	2.4%	1.18 (1.01, 1.38)
C61	Malignant neoplasm of prostate	2.3%	2.7%	0.86 (0.73, 1.02)
I10	Essential (primary) hypertension	2.3%	2.4%	0.98 (0.83, 1.16)
F179	Tobacco-related mental/behavioral disorders	2.3%	1.4%	1.57 (1.30, 1.89)^‡
I250	Atherosclerotic cardiovascular disease	1.9%	1.9%	0.97 (0.80, 1.18)
C189	Colon, unspecified	1.4%	1.3%	1.09 (0.87, 1.37)
F03	Dementia, unspecified	1.0%	1.2%	0.83 (0.64, 1.08)
E119	Non-insulin dependent diabetes mellitus	1.0%	1.1%	0.94 (0.72, 1.21)
I429	Cardiomyopathy, unspecified	1.0%	0.7%	1.45 (1.09, 1.92)^†
J439	Emphysema, unspecified	1.0%	0.4%	2.54 (1.85, 3.49)^‡
I64	Stroke, not specified	0.9%	0.9%	0.90 (0.68, 1.20)
C80	Malignant neoplasm, without specific site	0.8%	1.2%	0.69 (0.53, 0.92)^†

* p-value < 0.05; ^† p-value < 0.01; ^‡ p-value < 0.001; PMR = proportional mortality ratio.

Table 4 Cause of death based on second code, pre-existing and recent COPD PMR

Cause of death ICD-10 Code	Description	Preexistent COPD [% cause of death] N = 7,729	Recent COPD [% cause of death] N = 18,628	PMR (Preexistent recent) (95% CI)
J449	COPD, unspecified	11.3%	6.8%	1.66 (1.53, 1.80)^‡
I251	Atherosclerotic heart disease	6.1%	6.7%	0.91 (0.82, 1.01)
I500	Congestive heart failure	4.8%	4.6%	1.03 (0.92, 1.17)
I469	Cardiac arrest, unspecified	4.6%	5.3%	0.88 (0.78, 0.99)
J969	Respiratory failure, unspecified	3.9%	2.7%	1.45 (1.26, 1.67)^‡
J189	Pneumonia, unspecified	3.5%	3.5%	1.00 (0.87, 1.15)
I10	Essential (primary) hypertension	2.7%	2.8%	0.95 (0.81, 1.12)
I219	Acute myocardial infarction, unspecified	2.3%	2.8%	0.84 (0.71, 1.00)
F179	Tobacco-related mental/behavioral disorders	1.8%	1.7%	1.03 (0.84, 1.25)
J439	Emphysema, unspecified	1.5%	0.9%	1.75 (1.38, 2.22)^†
E149	Diabetes mellitus, without complications	1.1%	1.4%	0.79 (0.62, 1.01)
I64	Stroke, not specified	1.1%	1.1%	1.02 (0.79, 1.31)
I499	Cardiac arrhythmia, unspecified	1.1%	1.0%	1.08 (0.83, 1.40)
I48	Atrial fibrillation and flutter	1.1%	0.8%	1.37 (1.04, 1.79)
I250	Atherosclerotic cardiovascular disease	1.0%	1.2%	0.82 (0.63, 1.06)
R092	Respiratory arrest	0.9%	0.8%	1.08 (0.81, 1.43)
C780	Secondary malignant neoplasm of lung	0.7%	0.8%	0.86 (0.63, 1.18)
I255	Ischemic cardiomyopathy	0.6%	0.7%	0.85 (0.61, 1.20)
C787	Liver cancer, secondary	0.6%	0.6%	0.91 (0.64, 1.29)
I429	Cardiomyopathy, unspecified	0.5%	0.8%	0.65 (0.46, 0.92)

*p-value < 0.05; ^† p-value < 0.01; ^‡ p-value < 0.001; PMR = proportional mortality ratio.

Table 5 All-coded causes of death, preexistent and recent COPD

Cause of death ICD-10 Code	Description	Preexistent COPD [% cause of death] N = 7,729	Recent COPD [% cause of death] N = 18,628	PMR (Preexistent recent) (95% CI)
J449	COPD, unspecified	38.8%	24.3%	1.60 (1.54, 1.66)^‡
I251	Atherosclerotic heart disease	17.0%	18.4%	0.92 (0.87, 0.98)^†
C349	Lung/bronchial cancer, unspecified	15.2%	16.7%	0.91 (0.85, 0.97)^†
I500	Congestive heart failure	13.5%	13.3%	1.01 (0.95, 1.08)
J969	Respiratory failure, unspecified	12.2%	8.7%	1.40 (1.30, 1.51)^‡
I469	Cardiac arrest, unspecified	11.5%	12.3%	0.93 (0.87, 1.00)
J189	Pneumonia, unspecified	10.9%	9.6%	1.14 (1.05, 1.23)^†
I219	AMI, unspecified	9.3%	10.2%	0.94 (0.86, 1.02)
I10	Essential (primary) hypertension	6.7%	7.4%	0.91 (0.83, 1.00)
A419	Septicemia, unspecified	5.6%	5.9%	0.96 (0.86, 1.07)
E149	Diabetes mellitus, unspecified	5.1%	6.4%	0.79 (0.70, 0.88)^‡
J439	Emphysema, unspecified	4.9%	2.6%	1.89 (1.66, 2.16)^‡
F179	Tobacco-related mental/behavioral disorders	4.5%	3.8%	1.20 (1.06, 1.36)^†
N19	Unspecified renal failure	3.7%	4.6%	0.81 (0.71, 0.92)^†
I250	Atherosclerotic cardiovascular disease	3.4%	3.8%	0.89 (0.77, 1.02)
I48	Atrial fibrillation and flutter	3.3%	2.6%	1.26 (1.09, 1.46)^†
I64	Stroke, not specified	3.0%	4.1%	0.79 (0.68, 0.91)^‡
R092	Respiratory arrest	3.2%	2.9%	1.12 (0.97, 1.30)
C61	Prostate cancer	2.7%	3.0%	0.89 (0.76, 1.04)
I499	Cardiac arrhythmia, unspecified	2.4%	2.6%	0.94 (0.80, 1.11)

* p-value < 0.05; ^† p-value < 0.01; ^‡ p-value < 0.001.