Geographic Differences in Sex-Specific Chronic Obstructive Pulmonary Disease Mortality Rate Trends Among Adults Aged ≥25 Years - United States, 1999-2019

Abstract

Chronic obstructive pulmonary disease (COPD) accounts for the majority of deaths from chronic lower respiratory diseases, the fourth leading cause of death in the United States in 2019.* COPD mortality rates are decreasing overall. Although rates in men remain higher than those in women, declines have occurred among men but not women (1). To examine the geographic variation in sex-specific trends in age-adjusted COPD mortality rates among adults aged ≥25 years, CDC analyzed 1999-2019 death certificate data, by urban-rural status,^† U.S. Census Bureau region,^§ and state. Among women, no significant change in overall COPD mortality occurred during this period; however, rates increased significantly in small metropolitan (average annual percent change [AAPC] = 0.6%), micropolitan (1.2%), and noncore (1.9%) areas and in the Midwest (0.6%). Rates decreased significantly in large central (-0.9%) and fringe metropolitan (-0.4%) areas (and in the Northeast (-0.5%) and West (-1.2%). Among men, rates decreased significantly overall (-1.3%), in all urban-rural areas (range = -1.9% [large central metropolitan] to -0.4% [noncore]) and in all regions (range = -2.0% [West] to -0.9% [Midwest]). Strategies to improve the prevention, treatment, and management of COPD are needed, especially to address geographic differences and improve the trend in women, to reduce COPD deaths.

FIGURE 1

Sex-specific trends in age-adjusted chronic obstructive pulmonary disease mortality rates among adults aged ≥25 years,* by urban-rural status^† — United States, 1999–2019 Abbreviation: COPD = chronic obstructive pulmonary disease. * Per 100,000 population. Age-adjusted COPD mortality rates were calculated using the 2000 U.S. Census Bureau projected population and 10-year age groups. ^† As defined in the CDC National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties with six urbanization levels: four metropolitan (large central metro, large fringe metro, medium metro, and small metro) and two nonmetropolitan (micropolitan and noncore). https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf

FIGURE 2

State-level changes* in sex-specific age-adjusted chronic obstructive pulmonary disease mortality rates† among adults aged ≥25 years — United States, 1999–2019 Abbreviations: AAPC = average annual percent change; COPD = chronic obstructive pulmonary disease; DC = District of Columbia. * Statistically significant changes were determined using the estimated AAPC with all years included (1999–2019). AAPCs significantly <0 were interpreted as a significant decrease while those significantly >0 were interpreted as a significant increase. ^† Per 100,000 population. Age-adjusted COPD mortality rates were calculated using the 2000 U.S. Census Bureau projected population and 10-year age groups.