Life Expectancy in Chronic Obstructive Pulmonary Disease

Importance Chronic obstructive pulmonary disease (COPD) is a leading cause of death and age-standardized COPD mortality has increased substantially over the past few decades. Robust estimates of life expectancy and years of life lost (YLL) from COPD, which are important to patient care and policy decisions, are lacking. Objective To determine whether COPD is associated with lower life expectancy and whether the YLL are associated with disease severity. Design, Setting, and Participants The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 8 US general population cohorts. Participants aged 17 to 98 years were enrolled from 1983 to 2011 and followed up longitudinally through 2020. Data analysis was conducted from January 1, 2025, to January 15, 2026. Exposures Presence of COPD, which was defined by a prebronchodilator forced expiratory volume in 1 second (FEV 1 ) to forced vital capacity (FVC) ratio of less than 0.70 and disease stages per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Main Outcomes and Measures This study used a parametric proportional hazards model with a Gompertz baseline hazard function to estimate survival by GOLD stage from the time of initial spirometry. The multivariable hazards function was used to estimate life expectancy, adjusting for demographics, educational attainment, body mass index, smoking status, pack-years of smoking, diabetes, hypertension, and hypercholesterolemia. YLL was calculated in comparison with individuals with no airflow obstruction. Results Of 45 886 participants (mean [SD] age, 52.4 [15.8] years; 25 827 [56.3%] females), 13 869 (30.2%) died over a median follow-up of 15.2 (IQR, 9.7-27.1) years. COPD was present in 8058 participants (17.6%). In age-adjusted models, mean life expectancy for an individual aged 65 years was 21.5 (95% CI, 21.3-21.6) years without COPD, decreasing to 20.0 (95% CI, 19.7-20.4) years for GOLD stage 1, 16.4 (95% CI, 16.1-16.8) years for GOLD stage 2, 13.1 (95% CI, 12.5-13.8) years for GOLD stage 3, and 10.7 (95% CI, 8.9-12.6) years for GOLD stage 4. YLL were 0.71 (95% CI, 0.34-1.08) for GOLD stage 1, 2.58 (95% CI, 2.21-2.95) for GOLD stage 2, 5.07 (95% CI, 4.39-5.74) for GOLD stage 3, and 7.12 (95% CI, 5.21-9.04) for GOLD stage 4. Comparable decreases were noted for COPD in those who never smoked vs ever smoked. YLL for GOLD stages 2 to 4 were similar or greater than the YLL for hypertension (2.7; 95% CI, 2.4-3.0), diabetes (4.1; 95% CI, 3.7-4.4), obesity (0.5; 95% CI, 0.1-0.9), and cigarette smoking (5.5; 95% CI, 5.1-5.9). Conclusions and Relevance In this cohort study, COPD was associated with lower life expectancy, including in adults who never smoked.