COPD Linked to Reduced Life Expectancy Even in Never-Smokers: Study
USA: A study has found that Chronic Obstructive Pulmonary Disease is associated with reduced life expectancy, including among adults who have never smoked. The findings suggest that factors beyond smoking may contribute significantly to the long-term health burden and mortality risk associated with COPD.
The findings come from a large pooled analysis led by Surya P. Bhatt and colleagues at the University of Alabama at Birmingham, published in JAMA Internal Medicine. The study combined data from the National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study, integrating information from eight major US population-based cohorts. In total, 45,886 individuals aged 17 to 98 years were followed for up to several decades, with mortality outcomes tracked through 2020.
Researchers assessed the presence and severity of COPD using spirometry-based airflow limitation and categorized the disease according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. They then applied advanced survival modeling to estimate life expectancy and calculate years of life lost (YLL), while adjusting for key factors such as age, sex, smoking history, body mass index, and major comorbidities, including diabetes and hypertension.
Key Findings:
- Life expectancy decreased progressively with increasing severity of COPD.
- At age 65, individuals without airflow obstruction had an estimated remaining life expectancy of about 21.5 years.
- Life expectancy declined to 20.0 years in GOLD stage 1 COPD.
- It further decreased to 16.4 years in GOLD stage 2.
- In GOLD stage 3, life expectancy dropped to 13.1 years.
- In GOLD stage 4, it declined to 10.7 years.
- Years of life lost increased with disease severity, ranging from less than one year in early COPD to more than seven years in advanced stages.
- Reduced life expectancy was observed not only in smokers but also in individuals who had never smoked.
- Similar mortality patterns in never-smokers suggest COPD contributes to premature death independent of smoking status.
- Moderate to severe COPD was associated with years of life lost comparable to or greater than those of hypertension, diabetes, obesity, and, in some comparisons, cigarette smoking.
The study highlights COPD as a major contributor to premature mortality at the population level, reinforcing its status as a key non-communicable disease with wide public health impact. The burden extends beyond older smokers, affecting younger individuals and lifelong non-smokers as well.
The authors acknowledge several limitations. Lung function was assessed only at baseline, which may not fully reflect disease progression over time. Medication use was not included, and COPD was defined using pre-bronchodilator spirometry, which could lead to some misclassification. Smoking status was self-reported and captured only at enrollment, and overlap with asthma could not be completely ruled out.
Despite these constraints, the study provides strong evidence that COPD is linked to reduced life expectancy across all stages. The findings highlight the need for early diagnosis, sustained monitoring, and prevention strategies that go beyond smoking-related risk factors to reduce COPD-related premature deaths.
Reference:
Bhatt SP, Sun Y, Wang Y, et al. Life Expectancy in Chronic Obstructive Pulmonary Disease. JAMA Intern Med. Published online May 17, 2026. doi:10.1001/jamainternmed.2026.0207
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