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Chronic Obstructive Pulmonary Disease Among Adults — United States, 2011

Chronic obstructive pulmonary disease (COPD) is a group of progressive, debilitating respiratory conditions, including emphysema and chronic bronchitis, characterized by difficulty breathing, lung airflow limitations, cough, and other symptoms. COPD often is associated with a history of cigarette smoking and is the primary contributor to mortality caused by chronic lower respiratory diseases, which became the third leading cause of death in the United States in 2008 (1). Despite this substantial disease burden, state-level data on the prevalence of COPD and associated health-care resource use in the United States have not been available for all states. To assess the state-level prevalence of COPD among adults, the impact of COPD on their quality of life, and the use of health-care resources by those with COPD, CDC analyzed data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Among BRFSS respondents in all 50 states, the District of Columbia (DC), and Puerto Rico, 6.3% reported having been told by a physician or other health professional that they had COPD. In addition to the screening question asked of all respondents, 21 states, DC, and Puerto Rico elected to include an optional COPD module. Among persons who reported having COPD and completed the optional module, 76.0% reported that they had been given a diagnostic breathing test, 64.2% felt that shortness of breath impaired their quality of life, and 55.6% were taking at least one daily medication for their COPD. Approximately 43.2% of them reported visiting a physician for COPD-related symptoms in the previous 12 months, and 17.7% had either visited an emergency department or been admitted to a hospital for their COPD in the previous 12 months. 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.

BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized, U.S. civilian adult population aged ≥18 years, which is administered annually to households with landline and cellular telephones by state health departments in collaboration with CDC. Response rates for BRFSS are calculated using standards set by the American Association of Public Health Opinion Research response rate formula no. 4.* The response rate is the number of persons who completed the survey as a proportion of all eligible and likely eligible persons. The median survey response rate for all states and DC was 49.7% and ranged from 33.8% to 64.1%. Cooperation rates ranged from 52.7% to 84.3% (median: 74.2%).

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,§ DC, and Puerto Rico included additional questions for those who responded "yes." These persons were asked the following questions: "Have you ever been given a breathing test to diagnose your COPD, chronic bronchitis, or emphysema?" "Other than a routine visit, have you had to see a doctor in the past 12 months for symptoms related to shortness of breath, bronchitis, or other COPD, or emphysema flare?" "Did you have to visit an emergency room or be admitted to a hospital in the past 12 months because of your COPD, chronic bronchitis, or emphysema?" "How many different medications do you currently take each day to help with your COPD, chronic bronchitis, or emphysema?" and "Would you say that shortness of breath affects the quality of your life?" Age was standardized to the 2000 U.S. population, and prevalence estimates and 95% confidence intervals (CI) were calculated by state and by selected characteristics. Data were weighted using the new raking method (2). For comparisons of prevalence between subgroups, statistical significance (p<0.05) was determined using t-tests.

Overall, 6.3% of U.S. adults (an estimated 15 million) have been told by a health-care provider that they have COPD (age-adjusted prevalence: 6.0%) (Table 1). Prevalence of COPD increased, from 3.2% among those aged 18–44 years to >11.6% among those aged ≥65 years.

In age-adjusted comparisons, Hispanics were less likely to report COPD than non-Hispanic whites and blacks (4.0% compared with 6.3% and 6.1%, respectively). Women were more likely to report COPD than men (6.7% compared with 5.2%). Respondents who did not have a high school diploma reported a higher prevalence of COPD (9.5%) than those with a high school diploma (6.8%) or some college (4.6%). Respondents who were divorced, widowed, or separated were more likely to report COPD (9.4%) than married respondents (4.6%). Employment status also was related to a reported COPD diagnosis. COPD prevalence was higher among those who were unable to work (20.9%), unemployed (7.8%), or retired (7.6%) than among those who were homemakers or students (4.9%) or who were employed (3.8%). Reported COPD prevalence decreased with increasing household income, from 9.9% among those reporting a household income <$25,000 annually to 2.8% among those reporting ≥$75,000. More current smokers reported having COPD (13.3%) than former smokers (6.8%) or never smokers (2.8%). Respondents with a history of asthma also were significantly more likely to have been diagnosed with COPD (20.3%) than those without asthma (3.8%).

The prevalence of COPD varied considerably by state, from <4% in Puerto Rico, Washington, and Minnesota to >9% in Alabama and Kentucky. The median prevalence by state was 5.8% (range: 3.1%–9.3%). The states in the highest quartile for COPD prevalence clustered along the Ohio and lower Mississippi rivers (Figure). Among the 39,038 respondents with COPD in all states, 36.4% were former smokers, 38.7% were current smokers, and 43.7% had a history of asthma.

Among those 13,306 adults who reported having COPD and who answered the COPD module in 21 states, 76.0% (age-adjusted prevalence: 71.4%) reported having been diagnosed with COPD using a breathing test such as spirometry (Table 2). Among respondents with COPD, having a diagnosis with a breathing test increased with age. The age-adjusted percentage of COPD respondents reporting a breathing test was higher among non-Hispanic whites (71.7%) and non-Hispanic blacks (80.2%) than among Hispanics (58.5%), among those unable to work (82.2%) than among employed adults (67.2%), and among those with a history of asthma (81.4%) than among those without asthma (61.9%). Prevalence of having a breathing test did not differ between COPD respondents by sex, education level, household income, marital status, or smoking status. The age-adjusted percentage of COPD respondents reporting having had a breathing test ranged from 57.3% in Puerto Rico to 81.2% in Nevada, with a median percentage of 73.6%.

Among COPD module respondents, after age adjustment, an estimated 50.8% reported using at least one daily medication to manage their COPD-related symptoms, 41.5% reported seeing a physician for COPD symptoms in the past 12 months, and 18.6% reported a hospital or emergency department visit for their COPD in the previous 12 months (Table 2). Medication use for COPD increased among successive age groups, but no age-related patterns were observed in terms of physician or hospital visits for COPD symptoms. Among COPD module respondents, women were more likely to take daily COPD medications and to have had a physician visit related to COPD than men. Among COPD respondents, the age-adjusted percentages of those taking medication, having physician visits, and having hospital visits related to COPD were higher among those unable to work than for employed adults, were higher among persons also reporting an asthma history than among those without asthma, and declined among successively higher income groups. Taking COPD medications also declined with increasing education level, but visits to a physician or hospital for COPD did not differ by education level. Prevalence of medication use, physician visits, and hospital visits did not differ by race/ethnicity, marital status, or smoking status. The age-adjusted percentage of COPD respondents taking at least one daily COPD medication ranged from 41.4% in Oregon to 64.7% in DC. The percentage having seen a physician in the past 12 months for COPD ranged from 32.4% in Kansas to 50.9% in Utah. The percentage having visited a hospital or emergency department in the preceding 12 months for COPD ranged from 11.7% in Tennessee to 27.1% in Puerto Rico.

A majority (64.2%) of respondents to the COPD module felt that shortness of breath negatively impacted their quality of life (Table 2). No age-related trend was observed, but the age-adjusted percentages of COPD module respondents who reported a negative impact declined with increasing levels of education and income. The percentage was higher among persons who reported being unable to work than among employed persons, was higher among adults who were divorced, widowed, or separated compared with married adults, was higher among those with a history of asthma than among those without asthma, and was higher among current smokers and former smokers than among those who had never smoked. The age-adjusted percentage of COPD respondents who reported a negative impact of shortness of breath on their quality of life did not differ between groups defined by race/ethnicity or sex. The percentage reporting a negative impact of shortness of breath on quality of life ranged from 48.4% in Connecticut to 76.4% in Ohio.

Reported by

Nicole M. Kosacz, MPH, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee. Antonello Punturieri, MD, Thomas L. Croxton, MD, Monique N. Ndenecho, MPH, James P. Kiley, PhD, Gail G. Weinmann, MD, Div of Lung Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health. Anne G. Wheaton, PhD, Earl S. Ford, MD, Letitia R. Presley-Cantrell, PhD, Janet B. Croft, PhD, Wayne H. Giles, MD, Div of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Nicole M. Kosacz, nkosacz@cdc.gov, 770-488-5454.

Editorial Note

This is the first report of state-specific prevalence of COPD among adults in all 50 states, DC, and Puerto Rico and the first year in the history of BRFSS that a COPD module was included in the questionnaire. Additionally, this report provides state-level data regarding use of COPD-related health-care resources and COPD's impact on quality of life for selected states and territories. Nationally, 6.3% of adults reported physician-diagnosed COPD. This national average is consistent with results of previous research (3,4). State prevalences varied considerably, ranging from as low as 3.1% in Puerto Rico to as high as 9.3% in Kentucky. The southern states accounted for the highest prevalences of self-reported physician-diagnosed COPD, similar to geographic patterns previously reported for COPD hospitalizations (5) but not for mortality rates (6). Additional research is needed to determine the underlying causes of geographic clusterings, which might be related to geographic variations in other factors, including diagnostic practices, cigarette smoking, access to health care, and occupational and environmental exposures.

The patterns observed with respect to sex, age, race/ethnicity, income, and education are similar to those noted for COPD prevalence, hospitalizations, office visits, and mortality in other reports (4,6). Consistent with the literature, histories of smoking and of asthma were strongly and significantly correlated with COPD. Smoking cessation is important in prevention and also is critical in the management of COPD, given that smoking cessation might slow the decline in lung function associated with COPD (7). Finally, protection for all persons from exposure to secondhand smoke reduces respiratory symptoms of COPD and asthma (8).

This analysis also examined the prevalence of self-reported diagnosis by spirometry (the current standard for diagnosis) on a state-by-state basis. Although spirometry can be performed in a trained physician's office, approximately 20% of those who reported having COPD were not diagnosed with a breathing test. Diagnosis is an important first step, particularly because approximately 63% of U.S. adults with spirometry measurements of poor lung function indicative of COPD have never been diagnosed with COPD (9). In addition, spirometry also can help to stage the severity of disease and help to inform decisions about types of treatment that are appropriate. COPD makes it difficult for persons to work and results in lost wages and work days (10). Symptoms can be severe, and the majority of respondents with COPD asserted that their condition negatively impacts their quality of life. Although no cure for COPD currently exists, COPD is manageable through the use of medication and other interventions (10), which can improve quality of life and decrease lost work time. Of those surveyed, nearly 51% reported using daily medication to manage their COPD symptoms. Further research will have to determine what barriers to diagnosis and treatment exist (e.g., cost of and/or access to health-care resources). 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.

The findings in this report are subject to at least four limitations. First, BRFSS does not include persons from institutionalized settings, including those who are living in nursing or assisted-care facilities. Because COPD is associated with older age, this might result in underestimation of COPD prevalence. Second, COPD diagnosis was based on self-report as opposed to diagnosis using spirometry or review of medical records, possibly leading to underestimation or overestimation of prevalence. Similarly, self-reports of medical tests (e.g., spirometry) and medications also might be underreported or misclassified. Third, cooperation rates ranged from 52.7% to 84.3% (median: 74.2%). Finally, although all states conducted BRFSS surveys for households with cellular telephones only (in addition to the landline samples), not all states administered the optional COPD module as part of their cellular-only sample. However, a comparison of data from landline-only samples with the combined data for the nine states that did administer the module to users of cellular telephones revealed no significant differences in estimates.

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. 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.

References

  1. Kochanek KD, Xu J, Murphy SL, Miniño AM, Kung H. Deaths: final data for 2009. Natl Vital Stat Rep 2011;60(3).
  2. CDC. Methodologic changes in the Behavioral Risk Factor Surveillance System in 2011 and potential effects on prevalence estimates. MMWR 2012;61:410–3.
  3. Akinbami LJ, Liu X. Chronic obstructive pulmonary disease among adults aged 18 and over in the United States, 1998–2009. National Center for Health Statistics data brief no. 63. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2011.
  4. CDC. Chronic obstructive pulmonary disease surveillance—United States, 1971–2000. MMWR 2002;51(No. SS-6).
  5. Holt JB, Zhang X, Presley-Cantrell L, Croft J. Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States. Int J Chron Obstruct Pulmon Dis 2011;6:321–8.
  6. CDC. Deaths from chronic obstructive pulmonary disease—United States, 2000–2005. MMWR 2008;57:1229–32.
  7. Lee PN, Fry JS. Systematic review of the evidence relating FEV1 decline to giving up smoking. BMC Med 2010;8:84.
  8. Eisner MD, Balmes J, Yelin EH, et al. Directly measured secondhand smoke exposure and COPD health outcomes. BMC Pulm Med 2006;6:12.
  9. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the national health and nutrition examination survey, 1988–1994. Arch Intern Med 2000;160:1683–9.
  10. Rennard S, Decramer M, Calverley PMA, et al. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J 2002;20:799–805.

* Additional information available at http://www.aapor.org/standard_definitions2.htm.

The percentage of persons who completed interviews among all eligible persons who were contacted.

§ Arizona, California, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Jersey, North Carolina, Ohio, Oregon, Tennessee, Utah, and West Virginia.

Additional information available at http://www.nhlbi.nih.gov/health/public/lung/copd/lmbb-campaign.


What is already known on this topic?

Chronic obstructive pulmonary disease (COPD) is the primary contributor to mortality caused by chronic lower respiratory diseases, the third leading cause of death in the United States.

What is added by this report?

This report is the first analysis of COPD prevalence in all 50 states (plus the District of Columbia and Puerto Rico). The prevalence of COPD was 6.3% overall, but varied by state, age, race/ethnicity, and sex.

What are the implications for public health practice?

COPD is a leading cause of morbidity and mortality in the United States, and many U.S. residents are unaware they have it. States should heighten surveillance and target educational campaigns and other interventions in areas with a higher prevalence of COPD.


TABLE 1. Percentage of adults reporting having ever been told by a physician that they had chronic obstructive pulmonary disease (COPD),* by selected characteristics — Behavioral Risk Factor Surveillance System, United States, 2011

Characteristic

Total no. of respondents§

No. with COPD

%

(95% CI)

Total (crude)

498,225

39,038

6.3

(6.2–6.4)

Total (age-adjusted)

6.0

(5.9–6.1)

Age group (not adjusted) (yrs)

18–44

135,728

4,066

3.2

(3.0–3.4)

45–54

90,999

5,988

6.6

(6.3–6.9)

55–64

111,323

10,291

9.2

(8.9–9.5)

65–74

86,647

10,195

12.1

(11.7–12.6)

≥75

73,528

8,498

11.6

(11.1–12.0)

Race/Ethnicity

White, non-Hispanic

386,984

31,406

6.3

(6.2–6.5)

Black, non-Hispanic

40,063

2,988

6.1

(5.7–6.6)

Hispanic

37,849

1,767

4.0

(3.6–4.3)

Other, non-Hispanic

27,969

2,394

5.8

(5.3–6.3)

Sex

Men

195,831

13,249

5.2

(5.1–5.4)

Women

302,394

25,789

6.7

(6.5–6.9)

Employment status

Employed

243,147

8,799

3.8

(3.6–4.0)

Unemployed

30,442

2,535

7.8

(7.2–8.4)

Homemaker/Student

45,980

2,320

4.9

(4.5–5.3)

Retired

140,295

15,643

7.6

(5.8–9.8)

Unable to work

36,005

9,583

20.9

(19.9–21.9)

Education level

Less than high school diploma or GED

45,805

6,581

9.5

(9.0–10.0)

High school diploma or GED

147,260

14,350

6.8

(6.6–7.1)

At least some college

303,506

17,997

4.6

(4.5–4.7)

Annual household income

<$25,000

132,876

18,265

9.9

(9.6–10.2)

$25,000–$49,999

114,830

8,698

5.7

(5.5–6.0)

$50,000–$74,999

66,889

3,193

4.2

(3.9–4.5)

≥$75,000

113,178

3,131

2.8

(2.6–3.0)

Unknown

70,452

5,751

6.1

(5.8–6.4)

Marital status

Married

264,115

15,325

4.6

(4.5–4.8)

Divorced/Widowed/Separated

150,224

19,013

9.4

(9.0–9.8)

Never married

69,300

3,835

6.1

(5.7–6.5)

Member of unmarried couple

12,548

729

6.4

(5.5–7.5)

Smoking status

Current

83,352

13,310

13.3

(12.9–13.7)

Former

145,924

16,369

6.8

(6.5–7.1)

Never

266,538

9,220

2.8

(2.7–3.0)

Ever had asthma

Yes

64,319

16,534

20.3

(19.7–20.9)

No

433,906

22,504

3.8

(3.7–4.0)


TABLE 1. (Continued) Percentage of adults reporting having ever been told by a physician that they had chronic obstructive pulmonary disease (COPD),* by selected characteristics — Behavioral Risk Factor Surveillance System, United States, 2011

Characteristic

Total no. of respondents§

No. with COPD

%

(95% CI)

State/Area

Alabama

7,628

911

9.1

(8.2–10.0)

Alaska

3,508

215

5.9

(4.8–7.2)

Arizona

6,243

565

5.1

(4.4–5.9)

Arkansas

4,686

519

7.2

(6.3–8.2)

California

16,914

1,097

4.4

(4.1–4.9)

Colorado

13,440

884

4.6

(4.1–5.1)

Connecticut

6,724

434

5.7

(4.8–6.6)

Delaware

4,718

347

4.8

(4.1–5.6)

District of Columbia

4,476

244

4.6

(3.9–5.5)

Florida

12,241

1333

7.1

(6.5–7.9)

Georgia

9,859

859

6.9

(6.3–7.6)

Hawaii

7,547

396

4.2

(3.5–4.9)

Idaho

6,001

428

5.0

(4.4–5.8)

Illinois

5,452

414

5.9

(5.1–6.8)

Indiana

8,404

853

7.9

(7.2–8.6)

Iowa

7,272

443

4.6

(4.1–5.3)

Kansas

20,588

1,650

6.2

(5.8–6.7)

Kentucky

10,767

1,364

9.3

(8.5–10.2)

Louisiana

10,856

940

6.5

(5.9–7.3)

Maine

13,135

1,211

6.9

(6.3–7.4)

Maryland

9,951

675

5.8

(5.1–6.6)

Massachusetts

21,910

1,698

5.4

(5.0–5.9)

Michigan

10,943

1,042

7.4

(6.7–8.1)

Minnesota

15,234

724

3.9

(3.5–4.4)

Mississippi

8,856

854

7.9

(7.2–8.7)

Missouri

6,355

675

7.6

(6.8–8.4)

Montana

10,202

716

5.4

(4.8–6.1)

Nebraska

25,287

1,633

4.6

(4.3–5.0)

Nevada

5,397

473

6.9

(5.9–8.1)

New Hampshire

6,277

487

5.9

(5.2–6.7)

New Jersey

15,122

991

4.8

(4.4–5.3)

New Mexico

9,336

730

5.8

(5.2–6.4)

New York

7,603

503

5.6

(4.9–6.3)

North Carolina

11,406

1,023

6.5

(5.9–7.2)

North Dakota

5,246

293

4.4

(3.7–5.1)

Ohio

9,803

922

7.1

(6.4–7.8)

Oklahoma

8,506

934

8.0

(7.3–8.8)

Oregon

6,188

454

5.4

(4.8–6.2)

Pennsylvania

11,376

935

6.1

(5.5–6.7)

Rhode Island

6,426

492

5.9

(5.2–6.6)

South Carolina

12,845

1,208

7.1

(6.5–7.7)

South Dakota

8,209

553

4.9

(4.1–5.8)

Tennessee

5,859

653

8.7

(7.3–10.4)

Texas

14,834

1,215

5.5

(5.0–6.1)

Utah

12,540

595

4.2

(3.8–4.7)

Vermont

7,030

455

4.4

(3.9–5.0)

Virginia

6,518

502

5.8

(5.1–6.6)

Washington

14,630

842

3.9

(3.5–4.4)

West Virginia

5,246

529

8.0

(7.2–9.0)

Wisconsin

5,252

349

5.0

(4.1–6.1)

Wyoming

6,811

533

5.6

(5.0–6.4)

Puerto Rico

6,568

243

3.1

(2.7–3.6)

Median (range)

5.8

(3.1–9.3)

Abbreviations: CI = confidence interval; GED = General Education Development certificate.

* Includes emphysema and chronic bronchitis.

Age-adjusted to the 2000 U.S. standard population aged ≥18 years.

§ Unweighted sample. Categories might not sum to survey total because of missing responses.

Includes Asian, Native Hawaiian or other Pacific Islander, American Indian/Alaska Native, and multiracial.


FIGURE. Age-adjusted* prevalence of chronic obstructive pulmonary disease (COPD) among adults — Behavioral Risk Factor Surveillance System, United States,§ 2011

The figure shows age-adjusted prevalence of chronic obstructive pulmonary disease (COPD) among adults in the United States during 2011. The prevalence of COPD varied considerably by state, from <4% in Puerto Rico, Washington, and Minnesota to >9% in Alabama and Kentucky. The median prevalence by state was 5.8% (range: 3.1%-9.3%). The states in the highest quartile for COPD prevalence clustered along the Ohio and lower Mississippi rivers.

* Age-adjusted to the 2000 U.S. standard population, using five age groups: 18–44 years, 45–54 years, 55–64 years, 65–74 years, and ≥75 years.

Based on an affirmative response to the question, "Has a doctor, nurse, or other health professional ever told you that you have COPD, emphysema, or chronic bronchitis?"

§ Includes the 50 states, District of Columbia, and Puerto Rico.

Alternate Text: The figure above shows age-adjusted prevalence of chronic obstructive pulmonary disease (COPD) among adults in the United States during 2011. The prevalence of COPD varied considerably by state, from <4% in Puerto Rico, Washington, and Minnesota to >9% in Alabama and Kentucky. The median prevalence by state was 5.8% (range: 3.1%-9.3%). The states in the highest quartile for COPD prevalence clustered along the Ohio and lower Mississippi rivers.


TABLE 2. Percentage of selected chronic obstructive pulmonary disease (COPD)–related health-care behaviors among adults reporting COPD,* by selected characteristics — Behavioral Risk Factor Surveillance System, 21 states, District of Columbia, and Puerto Rico, 2011

Characteristic

Total no. with COPD

Had breathing test to diagnose COPD

Use at least one daily COPD medication

Seen by physician about COPD symptoms in preceding 12 mos

Visited hospital/ED for COPD in preceding 12 mos

COPD symptoms affect quality of life

(n = 13,306)

(n = 13,275)

(n = 13,284)

(n = 13,279)

(n = 13,290)§

No.

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

Total (crude)

13,306

76.0

(74.4–77.6)

55.6

(53.7–57.5)

43.2

(41.4–45.1)

17.7

(16.3–19.2)

64.2

(62.4–66.0)

Total (age-adjusted)

71.4

(68.6–74.0)

50.8

(47.9–53.8)

41.5

(38.7–44.3)

18.6

(16.5–20.9)

62.5

(59.6–65.3)

Age group (not adjusted) (yrs)

18–44

1,176

64.8

(59.8–69.6)

44.2

(39.0–49.5)

38.1

(33.3–43.2)

18.7

(15.1–22.8)

59.4

(54.2–64.4)

45–54

1,981

74.4

(70.8–77.8)

53.7

(49.2–58.2)

48.1

(43.6–52.5)

24.1

(20.2–28.6)

67.3

(62.8–71.5)

55–64

3,582

79.6

(77.1–81.9)

58.8

(55.6–61.8)

44.7

(41.6–47.9)

14.3

(12.5–16.3)

70.5

(67.5–73.3)

65–74

3,636

82.7

(80.0–85.0)

61.8

(58.9–64.7)

44.4

(41.5–47.4)

16.1

(13.9–18.6)

62.5

(59.6–65.4)

≥75

2,931

82.7

(80.2–85.0)

64.4

(61.4–67.4)

40.9

(37.8–44.1)

14.3

(12.3–16.5)

60.4

(57.1–63.5)

Race/Ethnicity

White, non-Hispanic

11,021

71.6

(68.4–74.7)

50.1

(46.6–53.5)

41.1

(37.9–44.5)

17.8

(15.3–20.6)

62.1

(58.7–65.4)

Black, non-Hispanic

865

80.2

(71.7–86.6)

56.8

(47.5–65.7)

41.3

(32.9–50.2)

24.9

(17.8–33.8)

72.8

(65.1–79.3)

Hispanic

581

58.5

(50.3–66.3)

49.5

(41.3–57.8)

48.2

(40.4–56.0)

21.2

(15.9–27.7)

58.5

(50.3–66.2)

Other, non-Hispanic**

730

74.9

(64.3–83.2)

54.9

(43.2–66.1)

44.3

(33.1–56.2)

15.9

(10.9–22.6)

55.9

(44.1–67.0)

Sex

Men

4,398

72.4

(67.7–76.7)

45.1

(40.4–49.8)

34.5

(30.3–38.9)

17.2

(13.8–21.2)

62.9

(58.0–67.5)

Women

8,908

70.6

(67.1–73.8)

55.2

(51.6–58.8)

46.8

(43.3–50.4)

19.7

(17.1–22.4)

62.3

(58.8–65.8)

Employment status

Employed

2,926

67.2

(62.8–71.4)

40.9

(36.6–45.4)

34.8

(30.9–38.8)

12.1

(9.8–14.8)

52.4

(47.7–57.1)

Unemployed

823

67.9

(60.6–74.5)

46.2

(38.6–54.0)

44.1

(36.5–51.9)

21.2

(14.8–29.4)

64.8

(57.9–71.2)

Homemaker/Student

780

69.2

(61.2–76.2)

51.5

(43.2–59.8)

36.9

(29.6–45.0)

18.1

(12.6–25.3)

54.7

(46.2–62.9)

Retired

5,569

75.5

(51.1–90.1)

67.9

(45.4–84.3)

59.9

(37.6–78.8)

††

74.4

(50.8–89.1)

Unable to work

3,161

82.2

(78.2–85.6)

68.0

(62.2–73.4)

54.1

(48.0–60.1)

29.1

(24.2–34.6)

83.1

(79.3–86.3)

Education level

Less than high school diploma or GED

2,167

73.7

(67.1–79.5)

57.6

(50.5–64.3)

44.0

(37.5–50.8)

24.2

(19.3–29.8)

73.9

(66.7–80.0)

High school diploma or GED

4,850

72.9

(68.4–77.0)

54.3

(49.3–59.3)

40.6

(36.1–45.3)

17.4

(14.0–21.5)

66.2

(61.6–70.5)

At least some college

6,262

68.7

(64.4–72.6)

44.1

(40.3–48.1)

40.8

(36.9–44.9)

16.2

(13.4–19.4)

53.2

(49.0–57.4)

Annual household income

<$25,000

6,114

72.5

(68.3–76.3)

59.1

(54.9–63.2)

46.9

(42.8–51.1)

25.5

(21.9–29.4)

73.0

(68.8–76.7)

$25,000–$49,999

3,014

71.1

(64.7–76.7)

48.7

(41.8–55.6)

39.1

(32.8–45.8)

14.4

(10.3–19.9)

58.4

(51.7–64.9)

$50,000–$74,999

1,106

68.8

(60.0–76.4)

41.3

(33.3–49.9)

32.3

(25.6–39.8)

7.3

(5.3–10.1)

41.4

(33.4–49.9)

≥$75,000

1,097

70.7

(61.8–78.3)

37.8

(31.0–45.1)

31.8

(25.7–38.7)

6.5

(4.0–10.2)

43.6

(35.7–51.8)

Unknown

1,975

70.7

(63.2–77.1)

47.7

(39.6–55.8)

44.0

(36.2–52.1)

20.4

(15.1–27.1)

66.8

(59.4–73.4)

Marital status

Married

5,223

71.3

(67.5–74.9)

47.5

(43.4–51.5)

42.1

(38.2–46.1)

16.3

(13.4–19.7)

58.8

(54.7–62.9)

Divorced/Widowed/Separated

6,557

72.5

(66.7–77.7)

59.9

(54.1–65.4)

45.3

(39.8–51.0)

23.2

(18.8–28.2)

70.1

(64.2–75.3)

Never married

1,244

69.7

(64.0–74.9)

48.1

(42.1–54.2)

40.2

(34.4–46.3)

18.9

(14.5–24.2)

62.8

(56.8–68.4)

Member of unmarried couple

237

75.1

(62.4–84.6)

44.7

(33.4–56.5)

33.5

(24.2–44.4)

14.5

(8.9–22.8)

57.2

(44.7–68.9)

Smoking status

Current

4,452

71.9

(68.1–75.5)

50.5

(46.3–54.6)

39.3

(35.3–43.4)

18.2

(15.0–21.8)

65.4

(61.4–69.2)

Former

5,719

76.4

(69.9–81.8)

55.2

(47.5–62.6)

43.3

(36.2–50.8)

19.9

(15.2–25.6)

68.8

(62.4–74.5)

Never

3,092

65.1

(59.8–70.0)

46.3

(41.2–51.4)

42.9

(38.4–47.5)

17.2

(14.1–20.9)

53.6

(48.6–58.6)

Ever had asthma

Yes

5,790

81.4

(77.7–84.6)

67.1

(63.0–71.0)

50.7

(46.7–54.7)

24.0

(20.6–27.6)

71.4

(67.5–75.1)

No

7,515

61.8

(57.5–65.9)

35.8

(31.8–40.1)

33.0

(29.2–37.0)

13.5

(11.2–16.2)

53.9

(49.6–58.2)


TABLE 2. (Continued) Percentage of selected chronic obstructive pulmonary disease (COPD)–related health-care behaviors among adults reporting COPD,* by selected characteristics — Behavioral Risk Factor Surveillance System, 21 states, District of Columbia, and Puerto Rico, 2011

Characteristic

Total no. with COPD

Had breathing test to diagnose COPD

Use at least one daily COPD medication

Seen by physician about COPD symptoms in preceding 12 mos

Visited hospital/ED for COPD in preceding 12 mos

COPD symptoms affect quality of life

(n = 13,306)

(n = 13,275)

(n = 13,284)

(n = 13,279)

(n = 13,290)§

No.

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

%

(95% CI)

State/Area

Arizona

516

66.0

(50.0–79.0)

41.6

(30.1–54.0)

42.8

(31.2–55.2)

17.1

(10.3–26.8)

66.0

(51.7–77.8)

California§§

706

65.5

(56.6–73.4)

49.3

(40.7–58.0)

38.7

(30.8–47.3)

16.1

(10.8–23.2)

56.2

(47.4–64.6)

Connecticut

408

79.7

(68.8–87.5)

58.2

(46.4–69.2)

40.1

(29.1–52.1)

21.4

(12.5–34.3)

48.4

(37.2–59.9)

District of Columbia§§

193

78.5

(54.4–91.8)

64.7

(44.6–80.6)

33.1

(21.4–47.4)

††

65.5

(44.2–82.0)

Illinois

386

70.6

(59.6–79.7)

48.7

(38.1–59.5)

41.2

(31.8–51.4)

18.4

(11.1–29.1)

59.3

(48.2–69.5)

Iowa§§

356

79.3

(68.7–87.0)

60.4

(46.6–72.8)

46.8

(33.2–60.9)

††

57.7

(43.6–70.8)

Kansas§§

670

70.3

(58.2–80.1)

46.9

(35.9–58.1)

32.4

(24.8–40.9)

13.1

(8.3–20.1)

68.7

(56.8–78.5)

Kentucky§§

1,266

74.7

(66.7–81.3)

54.5

(46.3–62.4)

46.9

(38.8–55.1)

24.6

(17.8–33.1)

71.8

(62.9–79.3)

Maine§§

347

79.2

(64.7–88.8)

61.2

(47.8–73.0)

49.9

(37.6–62.3)

18.4

(11.6–27.9)

68.5

(54.9–79.6)

Massachusetts§§

1,402

73.6

(65.9–80.1)

57.6

(49.8–65.1)

41.1

(33.7–49.0)

12.9

(10.0–16.5)

57.5

(49.6–65.1)

Michigan

995

60.1

(52.6–67.1)

44.5

(37.4–51.7)

39.2

(32.5–46.3)

19.2

(13.7–26.1)

54.8

(47.3–62.0)

Minnesota

639

65.9

(57.3–73.6)

44.3

(37.4–51.5)

38.1

(30.0–47.0)

20.1

(13.7–28.3)

49.7

(42.4–57.1)

Montana

660

65.1

(55.0–74.0)

46.7

(37.5–56.3)

41.2

(31.8–51.2)

15.4

(8.5–26.4)

59.9

(50.0–69.1)

Nebraska§§

1,008

61.8

(51.2–71.3)

45.8

(35.9–56.1)

46.1

(36.2–56.3)

16.6

(9.5–27.5)

49.9

(40.3–59.5)

Nevada§§

358

81.2

(70.0–88.8)

42.9

(28.8–58.2)

41.0

(27.7–55.9)

††

67.5

(54.3–78.3)

New Jersey§§

293

74.9

(64.1–83.3)

54.8

(43.0–66.1)

48.9

(37.7–60.2)

20.9

(12.8–32.4)

50.5

(39.1–61.9)

North Carolina

928

78.4

(71.7–83.9)

53.9

(45.9–61.8)

48.7

(40.9–56.6)

17.6

(12.5–24.2)

68.2

(60.4–75.1)

Ohio§§

483

81.0

(72.0–87.6)

51.5

(40.4–62.4)

40.9

(30.5–52.3)

22.8

(15.6–32.2)

76.4

(69.2–82.3)

Oregon§§

334

69.2

(54.2–81.1)

41.4

(28.6–55.5)

43.1

(29.2–58.1)

††

71.0

(58.9–80.7)

Tennessee

563

68.3

(52.4–80.8)

60.4

(45.5–73.6)

32.5

(23.0–43.6)

11.7

(7.3–18.3)

67.7

(52.4–79.9)

Utah§§

97

78.1

(58.2–90.1)

46.3

(28.7–64.7)

50.9

(32.4–69.1)

††

70.3

(51.1–84.3)

West Virginia

519

75.6

(68.4–81.6)

55.1

(46.9–63.1)

44.3

(36.4–52.5)

25.7

(18.6–34.5)

70.7

(62.8–77.5)

Puerto Rico§§

179

57.3

(44.6–69.2)

47.8

(36.2–59.6)

43.0

(32.2–54.5)

27.1

(18.1–38.5)

76.0

(62.3–85.9)

Abbreviations: CI = confidence interval; GED = General Education Development certificate; ED = emergency department.

* Includes emphysema and chronic bronchitis.

Age-adjusted to the 2000 U.S. standard population.

§ Sample sizes for the module questions differ because of missing responses.

Unweighted number of respondents with COPD who also were administered and responded to the module. (Numbers are for respondents to breathing test question.) Categories might not sum to survey total because of missing responses. State sample sizes are smaller than the number of COPD respondents in Table 1 because 1) some states administered module on landline telephone surveys only, 2) some states used split samples for optional modules, and 3) not all respondents who reported having COPD went on to answer the module questions.

** Includes Asian, Native Hawaiian or other Pacific Islander, American Indian/Alaska Native, and multiracial.

†† Relative standard error ≥0.3.

§§ COPD module administered to landline telephone respondents only.


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