Original Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) frequently coexist, yet mortality trends in patients with both conditions remain poorly characterized. METHODS: Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates from 1999 to 2020 for adults aged ≥ 25 years with COPD (ICD-10: J40-J44) as the underlying cause and CKD (N18) as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using 2000 US standard population. Trends were assessed via Joinpoint regression, with stratifications by sex, race/ethnicity, age, urbanization, census regions, and state. RESULTS: Deaths increased from 1,405 in 1999 to 5,277 in 2020. The AAMR increased from 0.79 in 1999 to 1.96 in 2020. The overall average annual percent change (AAPC) was + 4.71% (95% CI: 3.06-6.38). Mortality rates were higher in males (AAMR: 2.41) than females (AAMR: 1.65), though females had faster increases (AAPC + 5.86% vs. + 3.42%). The 85 + age group had the highest rates (27.98 per 100,000 population) and fastest growth (APC + 6.43%). non-Hispanic (NH) White individuals exhibited the steepest increase (AAPC + 5.25%), while NH Black individuals had no significant trend (AAPC - 0.22%). Nonmetropolitan areas had higher AAMRs (2.68) compared to metropolitan areas (1.82). Regionally, the Midwest recorded the highest AAPC (+ 5.32%) and 2020 AAMR (2.42). State-level AAPCs ranged from 1.5% to 7.0%. CONCLUSION: Rising COPD-related mortality among adults with CKD highlights a need for integrated pulmonary-renal care, targeted interventions for high-risk populations, and policies addressing rural healthcare access and environmental risk factors. These estimates reflect deaths certified with COPD as the underlying cause and CKD as a contributing cause, and therefore do not represent mortality among all individuals with coexisting COPD and CKD.