{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T08:37:59Z","timestamp":1767688679330,"version":"3.48.0"},"reference-count":42,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,10,19]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) incurs significant mortality worldwide. Less is known about the burden in the last decade across Europe. We report trends and variations in mortality for patients with COPD across 27 European countries from 2011 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>COPD mortality was extracted from the EUROSTAT database, using the International Classification of Diseases 10 codes J43 and J44 for each country. Age-standardised and sex-standardised mortality rates (SMR) were calculated and joinpoint regression identified average annual percentage change (AAPC) in deaths from 2011 to 2021. Global Burden of Disease tobacco prevalence data were used to try and best contextualise the mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall SMR in Europe for this period was 32.1 (95% CI 32.0 to 32.1) per 100\u2009000 person-years, with substantial geographical heterogeneity. There was a fivefold difference in mortality rates between the countries with the greatest versus the least deaths. Although there was an apparent 3% (95% CI \u22124.4% to \u22121.6%) decrease in average annual deaths from 2011 to 2021 across Europe, there was no significant change in deaths from 2011 to 2018, prior to the UK leaving the dataset (a noticeably high outlier in SMR) and the COVID-19 pandemic. A 2% reduction (95%\u2009CI \u22122.6% to \u22121.2%) in annual mortality rate was noted in males from 2011 to 2018, while females increased (AAPC 1.3% (95% CI 0.1% to 2.6)%) in the same time frame.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The plateau in COPD-related deaths across Europe from 2011 to 2018 demands focus. Geographical variation in mortality suggests under-reporting in some countries, which may underestimate the true burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003175","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T08:35:25Z","timestamp":1767688525000},"page":"e003175","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality trends in chronic obstructive pulmonary disease in 27 countries within Europe from 2011 to 2021"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2345-545X","authenticated-orcid":false,"given":"Ayushman","family":"Gupta","sequence":"first","affiliation":[{"name":"NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3103-2665","authenticated-orcid":false,"given":"Francesca","family":"Gonnelli","sequence":"additional","affiliation":[{"name":"NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK"},{"name":"Respiratory Unit, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0914-0416","authenticated-orcid":false,"given":"Tricia M","family":"McKeever","sequence":"additional","affiliation":[{"name":"NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-2557","authenticated-orcid":false,"given":"Rachael L","family":"Murray","sequence":"additional","affiliation":[{"name":"Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Hubbard","sequence":"additional","affiliation":[{"name":"NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9578-2249","authenticated-orcid":false,"given":"Charlotte E","family":"Bolton","sequence":"additional","affiliation":[{"name":"NIHR Nottingham BRC Respiratory Theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2026010600352223000_13.1.e003175.1","unstructured":"World Health Organisation . 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