Progress in Chronic Disease Prevention
Chronic Disease Reports: Chronic Obstructive
Pulmonary Disease Mortality -- United States, 1986
In 1986, 71,099 persons in the United States died from chronic
obstructive pulmonary disease (COPD) (i.e., chronic bronchitis
(International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM) 491), emphysema (ICD-9-CM 492), and
"chronic
airway obstruction, not otherwise classified" (ICD-9-CM 496))
(Table
1). Rates of COPD mortality increase with age and are 1.8 times
higher
in males than females and 2.8 times higher in whites than in blacks
(1).
Rates of COPD mortality, age-adjusted to the 1986 U.S. population,
were highest in the West (excluding Utah and Hawaii); rates were
also
high in Kentucky, West Virginia, and Maine (Figure 1, Table 1).
Rates
were lowest in Hawaii (16.9 per 100,000 population) and highest in
Wyoming (49.0 per 100,000).
The principal modifiable risk factor for COPD is cigarette
smoking;
risk varies by smoking status and gender of the smoker (Table 2)
(2).
For 1986, with established methods (3), it was estimated that 82%
of
COPD mortality was attributable to smoking.
Reported by: Div of Surveillance and Epidemiologic Studies,
Epidemiology Program Office; Office on Smoking and Health, Center
for
Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note
Editorial Note: Cigarette smoking accounts for most mortality
associated with COPD. Several factors can affect COPD mortality
patterns and may explain three apparent inconsistencies. First,
while
COPD mortality has increased by 33% since 1979 (4), the prevalence
of
smoking in the United States has declined steadily since 1965 (2);
this
may reflect the long latency between smoking exposure and death due
to
COPD (4).
Second, the prevalence of current smoking is higher in eastern
states
(5), where COPD rates are lower. The long latency between smoking
exposure and COPD occurrence also in part may account for this
contrast. Other geographic factors might also explain the
distribution
of COPD mortality: the migration of persons with chronic lung
disease
to the West (6) and differences in occupational or environmental
exposures.
Finally, the higher rate of COPD mortality in whites contrasts
with
the higher prevalence of current cigarette smoking in blacks (2).
This
pattern may be related to the higher mortality rates among younger
blacks from other causes (7).
References
1. NCHS. Vital statistics of the United States, 1986. Vol
II--Mortality, pt A. Hyattsville, Mary land: US Department of
Health
and Human Services, Public Health Service, 1988:105; DHHS
publication
no. (PHS)88-1122.
2. CDC. Reducing the health consequences of smoking: 25 years of
progress--a report of the Surgeon General. Rockville, Maryland: US
Department of Health and Human Services, Public Health Service,
1989;
DHHS publication no. (CDC)89-8411.
3. Morgenstern H, Bursic ES. A method for using epidemiologic data
to
estimate the potential impact of an intervention on the health
status
of a target population. J Community Health 1982;7:292-309.
4. CDC. Chronic disease reports: mortality trends--United States,
1979-1986. MMWR 1989;38: 189-91.
5. CDC. Regional variation in smoking prevalence and cessation:
Behavioral Risk Factor Sur veillance, 1986. MMWR 1987;36:751-4.
6. Lebowitz MD, Burrows B. Tucson epidemiologic study of
obstructive
lung diseases. II. Effects of in-migration factors on the
prevalence of
obstructive lung diseases. Am J Epidemiol 1975;102:153-63.
7. Davis RM, Novotny TE. The epidemiology of cigarette smoking and
its
impact on chronic obstructive pulmonary disease. Am Rev Respir Dis
(in
press).
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