Nicola A. Hanania, M.D., M.S.; Gulshan Sharma, M.D., M.P.H.; Amir Sharafkhaneh, M.D., Ph.D.

Disclosures

Semin Respir Crit Care Med. 2010;31(5):596-606. 

In This Article

Epidemiology of COPD in the Elderly

COPD remains a major worldwide public health problem. and it is currently the fourth leading cause of death in the United States.[1] COPD affects 10% of the general population, and its prevalence reaches 50% in heavy smokers.[2] However, the exact prevalence of COPD is underestimated due to its imprecise definition and measurement tools, which account for the large variation in prevalence estimates within and across different nations. Regardless of the underestimation of COPD, pooled analyses of prevalence studies show a stepwise rise in the prevalence of COPD with advancing age. Because increasing age is strongly associated with an increasing prevalence, COPD requiring medical attention usually occurs late in life, and it is expected to become the third leading cause of death and disability worldwide by the year 2020.[3] The prevalence of COPD in individuals 65 years of age and older was recently estimated to be 14.2% (11 to 18%) compared with 9.9% (8.2 to 11.8%) in those 40 years or older.[4] A recent multinational, cross-sectional study found a higher prevalence of COPD than previously reported. Using Global Obstructive Lung Disease (GOLD) classification to determine the severity of COPD in the United States, the prevalence of GOLD stage II or higher was 1.9% in individuals 40 to 49 years of age compared with 19.2% in those older than 70 years.[5] A twofold increase in the prevalence of COPD was observed for every 10-year increment in age.

COPD poses a major economic burden to the United States. The total cost of managing COPD in 2005 U.S. dollars was estimated at $38.8 billion, of which $21.8 billion represented direct costs.[6] COPD accounts for one fifth of all hospitalizations in individuals aged 75 years and older,[7] and comorbidities are common in patients with COPD and associated with significant additional health care cost. Medicare health care expenditures are 2.5 times higher for elderly patients with COPD compared with age-matched persons without the condition. COPD patients aged 65 years and older enrolled in a Medicare managed care plan have $20,500 in additional annual expenditure compared with age- and sex-matched comparison groups. This additional cost incurred by COPD patients is partly explained by the increased prevalence of comorbidities such as congestive heart failure, vascular disease, diabetes, renal disease, and cancer. The direct annual cost attributable to COPD per patient ranges from $6,100 to $6,600.[8] Therefore, adequately addressing the diagnosis and treatment of coexisting comorbidities is very important in containing cost, improving the quality of life, and prolonging survival in elderly patients with COPD.

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