Global Initiative for Chronic Obstructive Lung Disease - GOLD

GOLD_WR_05 8/18/05 12:56 PM Page 15
additional information is available from the WHO
Evidence for Health Policy Department 27 .) However,
inconsistent use of terminology for COPD causes
problems that do not arise for many other diseases.
For example, prior to about 1968 and the Eighth
Revision of the ICD, the terms "chronic bronchitis" and
"emphysema" were used extensively. During the
1970s, the term "COPD" increasingly replaced those
terms in the US and some but not all other countries,
making comparisons of COPD mortality in different
countries very difficult. However, the situation has
improved with the Ninth and Tenth Revisions of the
ICD, in which deaths from COPD or chronic airways
obstruction are included in the broad category of
"COPD and allied conditions" (ICD-9 codes 490-496
and ICD-10 codes J42-46).
The age-adjusted death rates for COPD by race and
sex in the US from 1960 to 1996 by ICD code are
shown in Figure 2-3 17 . COPD death rates are very
low among people under age 45 in the US, but then
increase with age, and COPD becomes the fourth or
fifth leading cause of death among those over 45 17 , a
pattern that reflects the cumulative effect of cigarette
smoking 28 . Although appreciable variations in mortality
across developed countries for both genders have been
reported 29 , these differences should be interpreted
cautiously. Differences between countries in death
certification, diagnostic practices, the structure of
health care systems, and life expectancy have an
appreciable impact on reported mortality rates.
Figure 2-3. Age-Adjusted* Death Rates for
Chronic Obstructive Pulmonary Disease by
Race and Sex, US 1960-1996 17
ECONOMIC AND SOCIAL
BURDEN OF COPD
Because COPD is highly prevalent and can be severely
disabling, direct medical expenditures and the indirect
costs of morbidity and premature mortality from COPD
can represent a substantial economic and social burden
for societies and public and private insurance payers
worldwide. Nevertheless, very little quantitative information
concerning the economic and social burden of COPD
is available in the literature today.
Economic Burden
Cost of illness studies provide insight into the economic
impact of a disease. Some countries attempt to separate
economic burden into disease-attributable direct and indirect
costs. The direct cost is the value of health care
resources devoted to diagnosis and medical management
of the disease. Indirect costs reflect the monetary
consequences of disability, missed work and school,
premature mortality, and caregiver or family costs resulting
from the illness. Data on these topics from developing
countries are not available, but data from the US and
some European countries provide an understanding of
the economic burden of COPD in developed countries.
United States. Figure 2-4 compares the estimated costs
of various lung disorders in the US in 1993. In 1993, the
annual economic burden of COPD in the US was estimated
at $23.9 billion 17 , including $14.7 billion in direct expenditures
for medical care services, $4.7 billion in indirect morbidity
costs, and $4.5 billion in indirect costs related to premature
mortality. With an estimated 15.7 million cases of COPD
in the US 30 , the estimated direct cost of COPD is $1,522
per COPD patient per year.
Rate/100,000 Population
ICD/7
ICD/8
ICD/9
Figure 2-4. Direct and Indirect Costs of
Lung Diseases, 1993 (US $ Billions) 17
White Male
Black Male**
Condition
Total
Cost
Direct
Medical
Cost
Mortality-
Related
Indirect
Cost
Morbidity-
Related
Indirect
Cost
Total
Indirect
Cost
White Female
Black Female**
1960 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 1996
*Age-adjusted to the 2000 standard **Nonwhite from 1960 to 1967.
COPD 23.9 14.7 4.5 4.7 9.2
Asthma 12.6 9.8 0.9 0.9 2.8
Influenza 14.6 1.4 0.1 13.1 13.2
Pneumonia 7.8 1.7 4.6 1.5 6.1
Tuberculosis 1.1 0.7 - - 0.4
Lung Cancer 25.1 5.1 17.1 2.9 20.0
BURDEN OF COPD 15