Chronic obstructive pulmonary disease (COPD): secondary care data

Data on hospital discharges for patients admitted with COPD are held in the Scottish Morbidity Records (SMR01), which also include linked data on deaths. The discharge data in SMR01 can be used as a surrogate to estimate COPD incidence, which refers to the number of new cases in a population in a given period of time. Incidence is defined here as the first admission due to COPD, or in the absence of admission, death due primarily to COPD based on a 10-year incidence look-back period.

Chart 1 shows COPD incidence in Scotland by sex from 2002/03 to 2024/25 using the European Standard Population for age standardisation. In 2024/25 COPD incidence in both sexes fell after a sharp decline during 2020/21 associated with the COVID-19 pandemic, and subsequent rise between 2021/22 and 2023/24. The decrease in incidence observed in 2020/21 can be explained by changes to the provision and use of healthcare services during the pandemic, with many facing barriers to accessing or being unwilling to access services. Statistics for these years should therefore be treated with caution.

In 2024/25, incidence of COPD was estimated at 106.1 cases per 100,000 population for males and 116.4 cases per 100,000 for females. This represents reductions of 11.9% and 5.9% for males and females respectively compared to the previous year. Incidence in both sexes remains 10-20% lower than prior to the pandemic.

Although historically COPD incidence has been higher in males, sex-based differences were eliminated around 2015/16. However, since 2022/23, incidence has been higher in females, with the gap widening in 2024/25. Incidence of new COPD cases is now estimated to be approximately 10% greater in females. 

In the long-term, COPD incidence has decreased in males by 36.3% since 2002/03. Incidence decreased by 7.0% for females over the same period.

Patterns of COPD over time can be understood more clearly by examining incidence rates in different age groups. As shown in Chart 2, incidence increases with age in both sexes. This is caused by the progressive nature of COPD, with the underlying lung damage occurring as a result of long-term exposure to tobacco smoke or other pollutants, as well as the well-described lag in the onset of smoking-related diseases (Lopez, 1994).

In under 65s and those aged 65 to 84, incidence has consistently been comparable between the sexes. In over 85s, rates have converged, driven primarily by a reduction in males. This decrease can be attributed to declining smoking rates since the 1970s (see the Smoking Data section for more information on smoking and COPD). A gradual increase in female over 85s is likely partially due to smoking rates peaking later in females than males (Lopez, 1994) and potentially due to increased susceptibility to smoking-related morbidity in females (Zysman & Raherison-Semjen, 2022).

More data on incidence and hospital admissions due to COPD, including breakdowns by council area and health board, can be found in the ScotPHO Profiles Tool.