Study: UK leads West in deaths from respiratory illnesses

The UK has a higher death rate from respiratory illnesses than other developed Western nations, according to a new study.

Deaths from all respiratory diseases except lung cancer were higher compared with 14 countries within the European Union and Norway, Canada, Australia and the United States, says the analysis of data from the World Health Organization.

Overall fatalities from respiratory diseases have been decreasing across all these countries between 1985 and 2015, according to the analysis, published Wednesday in the BMJ. Mortality in men was reduced in this period, but it remained approximately the same for women.

Respiratory diseases such as chronic obstructive pulmonary disease, known as COPD, are categorized as amenable diseases, says Dr. Justin Salciccioli, a resident and clinical fellow at Harvard Medical School and lead researcher on the analysis. “The relevance of that is that with effective, timely and appropriate health care delivery, these deaths should be avoidable,” he added.

The UK has been identified as an outlier on this issue, with work like an analysis of the 2010 Global Burden of Disease study pointing out that it has higher mortality rates for COPD, a disease that was responsible for 3.17 million deaths globally in 2015. Some of the main risk factors for COPD are smoking and air pollution.

The international research team led by Salciccioli goes beyond previous studies as it looks at whether these trends persist over a longer period and over a broad category of diseases.

In the UK, deaths from respiratory diseases from 1985 to 2015 fell from 151 per 100,000 men to 89; for women, the results went from 67 to 68 per 100,000, according to the new study.

In the other countries studied, death rates for men fell from 108 to 69 per 100,000 in this period; rates for women went from 35 to 37 per 100,000.

Salciccioli described the national comparisons as “a big difference.”

“That is one of the big reasons that we’ve pursued this question,” he added.

The difference seems to affect a broader category of diseases that affect the lung in general, according to Salciccioli.

“The cause for concern would be that this is a difference that persists over time more than an absolute difference,” he said.

Salciccioli explained that with respect to deaths in men with lung cancer, the UK is “just as good, if not better,” as the majority of comparator countries.

The study shows an observational trend and is not able to determine why there is a difference in death rates, but it is possible that lifestyle factors like smoking play a role, Salciccioli said.

Salciccioli hopes that the study will lead to a better understanding of what lies behind the differences between British mortality rates and those of other countries.

Previous researched has suggested that high tobacco consumption in the UK could be linked to differences in mortality from respiratory diseases. But smoking has been on the decline in the UK, the study says.

Pollution could be another possible explanation, the report’s authors added. A 2017 WHO study reported 25.7 deaths per 100,000 people in the UK attributable to household and ambient air pollution, a greater rate than in most comparator countries, according to the WHO data.

All countries studied showed a decrease in male mortality from respiratory conditions, but no sign of a decrease in female rates. Salciccioli believes that this is driven “by the legacy of smoking”: Men had historically higher rates of smoking, and there have been significant improvements in reducing these. Salciccioli is not sure that smoking rates were cut among women as much as they have in men.

Respiratory diseases are a large burden on health services, the study says. In 2016, they were among the top five killers globally, according to the Global Disease Burden report.

“These figures are sad, but they’re not surprising,” said Dr. Penny Woods, chief executive of the British Lung Foundation, who was not involved in the study. “We know that lung disease is the third biggest killer in the UK after cancer and heart disease.”