Impact of the COVID-19 pandemic on COPD patients: a nationwide mortality study in France

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients are a vulnerable population with an increased risk of death from COVID-19 if infected. To date, a reduction in hospitalizations for acute exacerbations of COPD has been reported in various contexts, but large population-based studies with mortality follow-up are lacking. We investigated the mortality patterns of COPD patients in France relative to a control population, comparing year 2020 to pre-pandemic years 2017-2019. METHODS: COPD patients were identified in the French National Health Data System based on their healthcare use. Four COPD cohorts were created, and followed for one year in 2017, 2018, 2019 and 2020, respectively. Corresponding control cohorts (without COPD) were created, matched on sex, age and residence, with a ratio of two controls per case. Survival was analyzed using Cox regressions and standardized rates. RESULTS: The four COPD cohorts included about a million and a half individuals each. All-cause mortality increased in 2020 compared to 2019 in the COPD population (hazard ratio (HR) [95% confidence interval]: 1.04 [1.03-1.05]), but to a lesser extent than in the control population (HR: 1.10 [1.08-1.11]). Non-COVID-19 mortality decreased to a greater extent in COPD patients (HR: 0.95 [0.94-0.96]) than in the controls (HR: 0.98 [0.97-0.99]). Death rate from COVID-19 was twice as high in the COPD population relative to the control population (547 vs 279 per 100,000 person-years). CONCLUSIONS: The direct impact of the pandemic in terms of deaths from COVID-19 was much greater in the COPD population than in the control population. However, the larger decline in non-COVID-19 mortality in COPD patients could reflect a specific protective effect of the containment measures on this population, counterbalancing the direct impact they had been experiencing. KEY MESSAGES: • During the COVID-19 pandemic, COPD patients experienced a slight increase in all-cause mortality, but relatively less than the rest of the population of the same age and sex structure. • In 2020, relative to a control population, COPD patients experienced substantially higher COVID-19 mortality and, at the same time, a greater reduction in non-COVID-19 mortality.