Editorial
Quantifying Life Expectancy and Years of Life Lost in a Large Contemporary Cohort of Individuals With COPD
Teva D. Brender, Deborah Grady
JAMA Intern Med Published Online: May 17, 2026
doi: 10.1001/jamainternmed.2026.0213
In this issue of JAMA Internal Medicine, Bhatt and colleagues1 use data from the National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study to quantify life expectancy and years of life lost (YLL) from chronic obstructive pulmonary disease (COPD). Compared with persons without COPD, the authors report that YLL among persons with COPD were 1.9 years. Increasing severity of COPD markedly increased YLL: for Global Initiative for COPD (GOLD) stages 1 through 4 (higher stage indicates more severe disease), YLL was 0.7 years for stage 1, 2.6 years for stage 2, 5.1 years for stage 3, and 7.1 years for stage 4. Among persons with COPD, there were no differences in YLL between smokers and never-smokers or by sex. Depending on the severity of COPD, YLL were similar to or greater than the YLL lost for hypertension (2.7), diabetes (4.1), obesity (0.5), and smoking (5.5). These results corroborate previous epidemiologic research and clinical experience: COPD carries substantial public health burden2 and mortality increases with increasing disease severity.3,4
This study1 has several key strengths. The NHLBI Pooled Cohorts Study encompasses more than 45 000 participants from 8 US general population-based studies with baseline prebronchodilator spirometry values. Participants were enrolled from 1983 to 2011 and followed up through 2020. This large contemporary cohort represents a diverse population (17.2% Hispanic or Latino, 18.1% non-Hispanic Black, and 59.1% non-Hispanic White) with a mean (SD) age of 52.4 (15.8) years. Notably, it also includes a substantial group of nonsmokers (48.8% never, 21.0% current, and 30.2% former smokers).
Leveraging the unique NHLBI Pooled Cohorts dataset, the authors modeled mean life expectancy stratified by age, sex, GOLD stage, and smoking status. These findings may be particularly important for counseling and clinical decision-making among younger patients. For example, an individual aged 45 years who currently smokes with GOLD stage 1 COPD has mean additional life expectancy of 29.6 years compared with 37.0 years for a former smoker.1 Thus, the study by Bhatt et al1 is an important contribution to the literature and can help patients with COPD and their clinicians clarify the impact of the disease and its severity to guide clinical decision-making and care planning.
