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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).


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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