Mortality trends and disparities in older U.S. adults with coexisting chronic obstructive pulmonary disease and Alzheimer’s disease, 1999—2023

Abstract

Objective: Chronic obstructive pulmonary disease (COPD) and Alzheimer’s disease (AD) are leading causes of death among older adults. Their coexistence complicates clinical management and increases disease burden; however, long-term national mortality trends for this comorbidity remain poorly characterized. Methodology: We conducted a retrospective analysis using U.S. mortality data from the CDC WONDER Multiple Cause of Death database (1999–2023) for individuals aged ≥65 years with both COPD (ICD-10: J40–J44) and AD (ICD-10: G30) listed as causes of death. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated across age, sex, race/ethnicity, census region, and urbanization level. Results: From 1999 to 2023, 151,250 deaths were recorded with COPD–AD comorbidity. Mortality increased significantly among adults ≥85 years (AAMR: 46.46 to 59.31 per 100,000; average annual percent change [AAPC] = 1.01%). Sex-specific trends diverged: AAMR declined in males (AAPC = −1.06%) but rose in females (AAPC = 1.31%). Geographically, the Northeast experienced a significant decline (AAPC = −1.61%), whereas both metropolitan (AAPC = 1.29%) and nonmetropolitan areas (AAPC = 2.02%) showed increases, with a steeper rise in nonmetropolitan regions. Conclusion: Mortality trends for COPD–AD comorbidity among older U.S. adults exhibited substantial demographic and geographic disparities over the 25-year period. These findings underscore the need for targeted public health strategies and further etiologic investigation.