Obstructive Lung Diseases |

Geographic Disparities in U.S. COPD Mortality (2000-2007) FREE TO VIEW

Xingyou Zhang*, PhD; James Holt, PhD; Anne Wheaton, PhD; Letitia Presley-Cantrell, PhD; Earl Ford, MD; Janet Croft, PhD
Chest. 2012;142(4_MeetingAbstracts):698A. doi:10.1378/chest.1386234
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PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Chronic obstructive pulmonary disease (COPD) is the third leading cause of U.S. deaths. Demographic disparities in COPD mortality are well recognized yet research is limited about geographic disparities. We explore geographic disparities at state and county levels and examine the influence of county-level rural-urban status and poverty on COPD mortality.

METHODS: We obtained 2000-2007 U.S. mortality, population, and 2006 urban-rural categorization data from NCHS and county-level poverty data from the US Census. COPD was defined for an underlying cause with ICD-10 codes J40-J44. Age-specific death rates (per 100,000) were calculated.

RESULTS: There were 962,109 total deaths with COPD as the underlying cause in 2000-2007 in the U.S.; 87.6% at ages >=65, 11.9% at ages 45-64, and only 0.5% at ages <45 years. Age-specific death rates were 21 and 291 for ages 45-64 and >=65 years, respectively. State-level COPD death rates ranged from 131(HI) to 415 (WY) for ages >=65 and from 9 (HI) to 38 (OK) for ages 45-64. COPD death rates for ages >=65 were 255 for large central metro areas, 277 for large fringe metro areas, 300 for medium metro areas, 325 for small metro areas, 327 for micropolitan areas, and 324 for non-core rural counties. Similarly, for ages 45-64, rates were 17, 16, 22, 26, 28, and 30, respectively, in those urban-rural categories. From the lowest to highest poverty quintiles, COPD death rates were 268, 304, 303, 298, and 281 for ages >=65, and 14, 22, 23, 24, and 26 for ages 45-64 years old.

CONCLUSIONS: Significant variations in COPD death rates were observed at both state and county levels. The consistent decreasing gradient in COPD mortality along the urban-rural continuum suggests a strong influence of urban/rural contexts. The inconsistent gradient along poverty quintiles implies that health insurance access was possibly associated with COPD mortality rates for the population aged 45-64.

CLINICAL IMPLICATIONS: These mortality results suggest that COPD patients, especially those in rural and poor areas, may benefit from additional case management and risk reduction.

DISCLOSURE: The following authors have nothing to disclose: Xingyou Zhang, James Holt, Anne Wheaton, Letitia Presley-Cantrell, Earl Ford, Janet Croft

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CDC, Atlanta, GA




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