Changes in causes and age of death in an eastern German county over a period of 14 years. Comparison of rural and urban populations. Focus on COPD and ischemic heart disease

Abstract

We aimed to determine whether the causes of death, age of death and burden of disease have changed in the last years and whether there are differences between males and females as well as urban and rural populations. We investigated the causes of death, comorbidities and age of death as a cross-sectional study of an entire Thuringian county (approximately 100,000 inhabitants; 5 small cities with a total of 63,050 inhabitants and about 36,950 inhabitants in the countryside) for a 14-year period. All death certificates that were issued between 2002 and 2015 were reviewed for a total of 18,868 cases. The data were checked, and causes of death were coded by ICD-10 code. Because traditionally most corpses are cremated in Germany, in 79.68% of all cases a second inspection of the corpse by a pathologist, forensic pathologist or coroner was carried out for clarification of the cause of death according to the Thuringian laws. During the 14-year period, the age of death increased from 70.61 years to 74.49 years for males and from 78.94 years to 82.44 years for females. While in most of the investigated diseases the age of death also increased in parallel to the average age of death, an antiparallel development was found for COPD: the age of death for males with COPD was reduced by 0.045 years and for females by 0.15 years during the observation period. The burden of disease as measured by disability-adjusted life years (DALY) also steadily increased for COPD in both genders. The highest number of lost years of life was found for lung/bronchial cancer in both genders and for breast cancer. The highest burden of disease was calculated for ischemic heart disease in men and breast cancer in women. In general, the age of death in rural areas was nearly the same as in urban areas. Only for death from ischemic heart disease was there an increase in the age of death for men living in rural areas after the opening of a local cardiac catheterization laboratory in 2008. In all cases men exhibited an earlier age of death than women. While in all other investigated diseases the age of death increased, it dropped for COPD. COPD seems to have become a more frequent cause of death in recent years.