Strengths
deaths, asthma, COPD, death
REGRESSION, COPD, ASTHMA
The main strength of our study was our initial cohort of 6062 persons from a well-responded postal questionnaire (76% response rate), from which, we could assess a JEM value for 5271 individuals at the baseline, although it is possible that some selection bias exists as the response rate was better in females than in men. Our study setting allowed us a long 24 years of follow-up time. We could also get smoking status and self-reported physician made diagnoses for asthma and COPD at the start. From the occupational categorizations made from the occupation title of the principal long-term occupation, we could form an education level for everyone based on the typical time of post-comprehensive education for the occupation category.All deaths in Finland are recorded to the national statistics services (Statistics Finland) alongside the cause of death. In Finland, both a main and an immediate cause of death alongside up to four additional contributing factors to the cause of the death are assessed. This assessment is done either by an attending medical professional or in cases where the cause of death is not immediately clear enough an autopsy can be called, and it is done by a trained pathologist. The death certificates are also always validated by a forensic medical expert at Statistics Finland before entering them to the register. All underlying, immediate, and contributing causes of death are registered with a corresponding ICD-10 code.High age of the participant is associated with COPD diagnose and asthma and COPD coexistence. To mitigate its effect in our results, we also analyzed separately participants who were 50 years or older at baseline with a Kaplan-Meier survival model, and the results in this analysis were similar to those in the Cox regression model.The Finnish reimbursement system and the Finnish Social Security guidelines have likely caused that the given self-reported diagnoses have a good specificity, especially with the asthma diagnosis.