COPD Prevalence Rates Reported by All 50 States

Jennifer Garcia

November 26, 2012

A new report from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health provides the first report of state-level chronic obstructive pulmonary disease (COPD) prevalence as well as associated healthcare resource use. The findings were published in the November 23 issue of the Morbidity and Mortality Report.

The researchers found that the age-adjusted prevalence of COPD is considerably variable from state to state, ranging from less than 4% prevalence in Puerto Rico, Washington state, and Minnesota to more than 9% prevalence in Alabama and Kentucky. The overall prevalence among US adults is 6.3% (an estimated 15 million people) and appears to increase with age, with a higher than 11.6% prevalence seen in adults aged 65 years or older compared with a prevalence rate of 3.2% in those aged 18 to 44 years.

COPD was reported more commonly among non-Hispanic whites and blacks than among Hispanics (6.3% and 6.1% compared with 4.0%, respectively), and women were more likely to report COPD than men (6.7% vs 5.2%). Prevalence decreased with increasing income, "from 9.9% among those reporting a household income <$25,000 annually to 2.8% among those reporting ≥ $75,000," and respondents with a history of asthma were more likely to have been diagnosed with COPD than those without (20.3% vs 3.8%, respectively).

"Continued surveillance for COPD, particularly at state and local levels, is critical to 1) identify communities that likely will benefit most from awareness and outreach campaigns and 2) evaluate the effectiveness of public health efforts related to the prevention, treatment, and control of the disease," lead epidemiologist Nicole Kosacz, MPH, from Oak Ridge Institute for Science and Education in Tennessee, and colleagues write.

Data from the 2011 Behavioral Risk Factor Surveillance System, which collects information via telephone survey of noninstitutionalized individuals aged 18 years or older, was used for the analysis. The survey is administered annually by state health departments in collaboration with the CDC, and data are collected from all 50 states, the District of Columbia, and Puerto Rico. In 2011, nearly 500,000 people responded to the survey. Median response rates ranged in different states from 33.8% to 64.1%.

All respondents were asked: "Have you ever been told by a doctor or health professional that you have COPD, emphysema, or chronic bronchitis?" Surveys administered in 21 states, the District of Columbia, and Puerto Rico included additional questions for those who responded "yes" to this initial question.

Additional Data From 21 States

Data from 21 states, the District of Columbia, and Puerto Rico documented that 64.2% (95% confidence interval [CI], 62.4% - 66.0%) of respondents felt that shortness of breath had a negative effect on their quality of life; 55.6% (95% CI, 53.7% - 57.5%) were taking at least 1 medication a day to manage their COPD, with rates of medication usage increasing with age; and 76.0% (95% CI, 74.4% - 77.6%) had been given a diagnostic breathing test (spirometry).

"The overall prevalence of COPD and its associations with health-care utilization and quality of life make it a serious public health burden that needs to be addressed, especially in areas where the prevalence remains well above the national average," the authors write.

Of the respondents from this subset, 43.2% (95% CI, 41.4% - 45.1%) reported seeing a physician for COPD-related symptoms in the past 12 months. Visits to a hospital or emergency room in the preceding 12 months were lowest in Tennessee (11.7%; 95% CI, 7.3% - 18.3%) and highest in Puerto Rico (27.1%; 95% CI, 18.1% - 38.5%), with a collective prevalence of 17.7% (95% CI, 10.3% - 26.8%) for the 21 states together with Puerto Rico and the District of Columbia.

The report authors note that spirometry for the diagnosis of COPD is a simple test that can be performed in the office setting; however, nearly 20% of respondents who reported having COPD were not diagnosed with a breathing test. "Access to health care and insurance coverage are possible issues, given that wide geographic variation was observed in the reporting of spirometry and medication use in this study," Kosacz and colleagues write.

The authors also note possible limitations of the report, such as the exclusion of institutionalized individuals (eg, those living in nursing homes or assisted care facilities), which may have resulted in the underestimation of prevalence. In addition, data regarding the diagnosis of COPD, medical tests performed, and medications administered were based on self-report and may have affected prevalence data.

"This analysis provides an important starting point for states to quantify the burden of COPD locally and target their resources, as well as to evaluate the effectiveness of education and awareness programs such as the National Heart, Lung, and Blood Institute's 'Learn More, Breathe Better' campaign in those states," the authors conclude.

Morb Mortal Wkly Rep. 2012;61:938-943. Full text