Trends in mortality with chronic obstructive pulmonary disease as the underlying cause and chronic kidney disease as a contributing cause among US adults, 1999-2020: a CDC WONDER analysis.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) frequently coexist, yet mortality trends in patients with both conditions remain poorly characterized.

METHODS

Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates from 1999 to 2020 for adults aged ≥ 25 years with COPD (ICD-10: J40-J44) as the underlying cause and CKD (N18) as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using 2000 US standard population. Trends were assessed via Joinpoint regression, with stratifications by sex, race/ethnicity, age, urbanization, census regions, and state.

RESULTS

Deaths increased from 1,405 in 1999 to 5,277 in 2020. The AAMR increased from 0.79 in 1999 to 1.96 in 2020. The overall average annual percent change (AAPC) was + 4.71% (95% CI: 3.06-6.38). Mortality rates were higher in males (AAMR: 2.41) than females (AAMR: 1.65), though females had faster increases (AAPC + 5.86% vs. + 3.42%). The 85 + age group had the highest rates (27.98 per 100,000 population) and fastest growth (APC + 6.43%). non-Hispanic (NH) White individuals exhibited the steepest increase (AAPC + 5.25%), while NH Black individuals had no significant trend (AAPC - 0.22%). Nonmetropolitan areas had higher AAMRs (2.68) compared to metropolitan areas (1.82). Regionally, the Midwest recorded the highest AAPC (+ 5.32%) and 2020 AAMR (2.42). State-level AAPCs ranged from 1.5% to 7.0%.

CONCLUSION

Rising COPD-related mortality among adults with CKD highlights a need for integrated pulmonary-renal care, targeted interventions for high-risk populations, and policies addressing rural healthcare access and environmental risk factors. These estimates reflect deaths certified with COPD as the underlying cause and CKD as a contributing cause, and therefore do not represent mortality among all individuals with coexisting COPD and CKD.