Objective  To understand the competitive risks of survival outcomes among patients with chronic obstructive pulmonary disease (COPD) in Zhejiang province, thereby providing evidence-based reference for formulating management and intervention programs for this population.

Methods Incidence cases of COPD from January 1, 2014 to December 31, 2023 were collected from the COPD Surveillance Database of Zhejiang Provincial Center for Disease Control and Prevention, and death data from January 1, 2014 to December 31, 2024 were collected from the Death Surveillance Database. Death outcomes were matched for COPD patients. With death from respiratory diseases as the target event and malignant tumors, cerebrovascular diseases, heart disease, and other diseases as competing events, sex- and age-specific competing risk analyses were performed based on the time and underlying cause of death.

Results Among the 824 536 new COPD cases in Zhejiang province from 2014 to 2023, death outcome was observed in 211 586 cases. The 1-year, 5-year, and 10-year mortality probabilities were 0.089, 0.258, and 0.425, respectively. Respiratory diseases remained the primary risk of death (10-year cumulative risk: 0.150), followed by malignant tumors (10-year cumulative risk: 0.115, with lung cancer at 0.063 and other malignant tumors at 0.052). Cerebrovascular diseases had the lowest risk of death (10-year cumulative risk: 0.051). Stratified analysis showed that for male COPD patients, the malignant tumors had the highest cumulative risk within 3 years (3-year cumulative risk: 0.063), and respiratory diseases became the factor with the highest cumulative risk after 3 years (10-year cumulative risk: 0.162). For female patients, respiratory diseases consistently posed the highest cumulative risk (10-year cumulative risk: 0.120). For patients aged < 65 years, the risk of malignant tumors was the highest (10-year cumulative risk: 0.050); for those aged ≥65 years, the risk of respiratory diseases was the highest (10-year cumulative risk: 0.206). Other factors demonstrated similar risks, which were much lower than that of respiratory diseases.

Conclusions COPD patients face complex mortality patterns, and their competitive risks show significant age and sex differences. This highlights the importance of developing personalized and multidisciplinary integrated intervention strategies for different patient subgroups to effectively improve the prognosis of COPD patients.