title: COPD-Related Mortality and Co-morbidities in Northeastern Italy, 2008-2012: A Multiple Causes of Death Analysis.
abstract: BACKGROUND
  Analysis of COPD mortality based only on the underlying cause of death (UCOD) derived from death certificates underestimates disease burden. We analyzed the burden of COPD, as well as the pattern of reporting COPD and its co-morbidities in death certificates, using multiple-cause of death (MCOD) records.
  
  
  METHODS
  All 220,281 death certificates of decedents aged ≥ 40 years in the Veneto region (northeastern Italy) were analyzed through 2008-2012. The UCOD was selected by the Automated Classification of Medical Entities software. COPD was defined by ICD-10 codes J40-J44 and J47 based either on the UCOD or on any mention of COPD in death certificates (MCOD). Annual age-standardized COPD death rates were computed for 40-85 year-old subjects.
  
  
  RESULTS
  COPD was mentioned in 7.9% (and selected as the UCOD in 2.7%) of death certificates. In about half of these, COPD was mentioned in Part II only. After circulatory and neoplastic diseases, the most frequent chronic diseases reported in certificates with any mention of COPD were diabetes (15.2%) and dementia/Alzheimer (8.9%). Between 2008 and 2012, age-standardized death rates (/100,000/year) decreased from 39.8 to 34.0 in males and from 12.7 to 11.3 in females in the UCOD analyses. These trends were confirmed, although figures were three times greater, in the MCOD analyses.
  
  
  CONCLUSIONS
  MCOD analysis should be adopted to fully evaluate the burden of COPD-related mortality. Our findings support a decreasing trend in COPD-related mortality in northeastern Italy between 2008 and 2012, in line with other recent studies in Europe and beyond.
authors.affiliation: a Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona , Verona , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marcon
authors.affiliation: b SER - Regional Epidemiological Department , Veneto Region , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Saugo
authors.affiliation: b SER - Regional Epidemiological Department , Veneto Region , Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Fedeli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000401:mortality*
keywords: cause of death; chronic obstructive pulmonary disease; co-morbidity; death certificate; medical records; observational study