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Original Research: COPD |

Prevalence, Incidence, and Lifetime Risk for the Development of COPD in the Elderly: The Rotterdam Study

Yannick M. T. A. van Durme, MD; Katia M. C. Verhamme, MD, PhD; Theo Stijnen, MD, PhD; Frank J. A. van Rooij, DSc; Geert R. Van Pottelberge, MD; Albert Hofman, MD, PhD; Guy F. Joos, MD, PhD, FCCP; Bruno H. Ch. Stricker, MB, PhD; Guy G. Brusselle, MD, PhD
Author and Funding Information

*From the Department of Respiratory Diseases (Drs. van Durme, Van Pottelberge, Joos, and Bruselle), Ghent University Hospital, Ghent, Belgium; Department of Epidemiology and Biostatistics (Drs. Verhamme, van Rooij, Hofman, and Stricker), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Medical Statistics and Bioinformatics (Dr. Stijnen), Leiden University Medical Center, Leiden, the Netherlands.

Correspondence to: Bruno H. Ch. Stricker, MB, PhD, Department of Epidemiology and Biostatistics, Erasmus University Medical Center, PO Box 2040, 3000 DR Rotterdam, the Netherlands; e-mail: b.stricker@erasmusmc.nl


The Rotterdam Study is supported by Erasmus Medical Center Rotterdam; the Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development; the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; and the Ministry of Health, Welfare and Sports. This study was supported by the Netherlands Organization for Scientific Research grants 904-61-093 and 918-46-615. Dr. van Durme received a travel grant by the Belgian Thoracic Society and is a doctoral research fellow of the Fund for Scientific Research Flanders (Vlaanderen).

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):368-377. doi:10.1378/chest.08-0684
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Background:  COPD is a major cause of chronic morbidity and mortality throughout the world. Although the prevalence of COPD is already well documented, there are only few studies regarding the incidence of COPD.

Methods:  In a prospective population-based cohort study among subjects aged ≥ 55 years, COPD was diagnosed with an algorithm based on the validation of hospital discharge letters, files from the general practitioner, and spirometry reports.

Results:  In this study cohort of 7,983 participants, 648 cases were identified with incident COPD after a median follow-up time of 11 years (interquartile range, 7.8 years). This resulted in an overall incidence rate (IR) of 9.2/1,000 person-years (PY) [95% confidence interval (CI), 8.5 to 10.0]. The IR of COPD was higher among men (14.4/1,000 PY; 95% CI, 13.0 to 16.0) than among women (6.2/1,000 PY; 95% CI, 5.5 to 7.0), and higher in smokers than in never-smokers (12.8/1,000 PY; 95% CI, 11.7 to 13.9 and 3.9/1,000 PY; 95% CI, 3.2 to 4.7, respectively). Remarkable was the high incidence in the youngest female age category of 55 to 59 years (7.4/1,000 PY; 95% CI, 4.1 to 12.6). For a 55-year-old man and woman still free of COPD at cohort entry, the risk for the development of COPD over the coming 40 years was 24% and 16%, respectively.

Conclusion:  The overall incidence of COPD in an elderly population is 9.2/1,000 PY, with a remarkably high incidence in the youngest women, suggesting a further shift toward the female sex in the gender distribution of COPD. During their further lives, one of four men and one of six women free of COPD at the age of 55 years will have COPD develop.

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