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The purpose of the study was to evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across sex and socioeconomic status classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e., trend effect) in monthly severe exacerbation and mortality rates after 03\/2013 and 02\/2015 compared to the tiotropium period (04\/2007 to 02\/2013). Cohorts of individuals\u2009&gt;\u200965 years with COPD were created from the nationally representative database of the Quebec Integrated Chronic Disease Surveillance System in the province of Quebec, Canada. Whether these trends were similar for men and women and across different socioeconomic status classes was also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 130,750 hospitalizations for severe exacerbation and 104,460 deaths, including 24,457 (23.4%) respiratory-related deaths, over the study period (928,934 person-years). Significant changes in trends were seen after 03\/2013 for all-cause mortality (-1.14%\/month;95%CI -1.90% to -0.38%), which further decreased after 02\/2015 (-1.78%\/month;95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%\/month;95%CI -4.38% to -0.47%) and severe exacerbation (-1,90%\/month;95%CI -3.04% to -0.75%) rates were only observed after 02\/2015. These observations tended to be more pronounced in women than in men and in higher socioeconomic status groups (less deprived) than in lower socioeconomic status groups (more deprived).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The arrival of newer bronchodilators was chronologically associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD\u2009&gt;\u200965 years. Our findings document population benefits on key patient-relevant outcomes in the years following the introduction of newer once-daily long-acting bronchodilators and their combinations, which were likely multifactorial. Public health efforts should focus on closing the gap between lower and higher socioeconomic status groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-024-03277-2","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T13:02:39Z","timestamp":1726232559000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Trends in COPD severe exacerbations, and all-cause and respiratory mortality, before and after implementation of newer long-acting bronchodilators in a large population-based cohort"],"prefix":"10.1186","volume":"24","author":[{"given":"Charles-Antoine","family":"Guay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Maltais","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Beaudoin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Hugues","family":"Carmichael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elhadji Anassour","family":"Laouan Sidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie","family":"Perreault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Sirois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steeve","family":"Provencher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"issue":"10258","key":"3277_CR1","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","volume":"396","author":"T Vos","year":"2020","unstructured":"Vos T, Lim SS, Abbafati C, et al. 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This study was reviewed and approved by the Laval University institutional review board (2021\u2009\u2212\u2009271).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Charles-Antoine Guay reports financial support was provided by Quebec Health Research Fund. Francois Maltais reports a relationship with GlaxoSmithKline that includes: funding grants and speaking and lecture fees. Francois Maltais reports a relationship with AstraZeneca that includes: consulting or advisory and funding grants. Francois Maltais reports a relationship with Sanofi that includes: funding grants. Francois Maltais reports a relationship with Novartis that includes: funding grants and speaking and lecture fees. Francois Maltais reports a relationship with Boehringer Ingelheim that includes: funding grants and speaking and lecture fees. Francois Maltais reports a relationship with Grifols that includes: funding grants and speaking and lecture fees. Francois Maltais reports a relationship with Oxynov that includes: equity or stocks. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"None.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Footnotes"}}],"article-number":"450"}}