Inclusion Criteria:  Must have had at least one visit to a physician with a diagnosis of COPD (by ICD-9(-CM) 491-492, 496) or one hospital separation with a diagnosis of COPD (ICD-10-CA J41-44). Incidence criteria included 5 year washout period in which they were not in Alberta, Canada but did not have any diagnosis of COPD Individuals that meet this criteria with a new diagnosis in the last 3 years will be included in the cohort, thus individuals with their 'incident' diagnosis of COPD in the last three years will be included (01-APR-2016 to 31-MAR-2017, 01-APR-2017 to 31-MAR-2018; 01-APR-2018 to 31-MAR-2019)  Exclusion Criteria:  Individuals that were diagnosed with COPD prior to or after the enrollment period. Individuals that did not live in Alberta (with access to Alberta health care) during the five year washout period