Poverty, rural living linked to increased COPD mortality in the US

New research from the Centers for Disease Control and Prevention (CDC) underscores the widespread disparities associated with chronic obstructive pulmonary disease (COPD) mortality by state, poverty level, and urban vs rural location. The study, presented at CHEST 2012, the annual meeting of the American College of Chest Physicians (ACCP), found that COPD mortality is highest in rural and poor areas.

"Many factors contribute to the differences in COPD mortality, including smoking prevalence, air quality, and access to health care," said study co-author James B. Holt, PhD, MPA, of the CDC in Atlanta. "People with COPD who live in rural or poor areas have an even greater disadvantage. COPD patients, especially those in rural and , may benefit from additional case management and risk reduction."

To determine the geographic disparities related to COPD mortality, Dr. Holt and his research team from the CDC examined the influence of county-level rural-urban status and poverty on COPD mortality. The team obtained the 2000-2007 US mortality, population, and 2006 urban-rural categorization data from the National Center for Health Statistics and county-level poverty data from the US Census. Age-specific death rates (per 100,000) were calculated.

Preliminary results from the study indicate there were 962,109 total deaths with COPD as the underlying cause in 2000-2007 in the United States. Of the total COPD deaths, 87.6% was seen in ages ≥65; 11.9% in ages 45-64; and 0.5% in 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.

Preliminary results also indicated differences in COPD mortality by geographic location and , with the lowest COPD mortality found in large central and the highest found in non-core rural counties. Increased poverty also was associated with increased for the age group of 45-64 years old, but this was not observed in the age group 65 years and older.

According to the CDC, chronic lower respiratory disease (primarily COPD) is the third leading cause of death in the United States, and cigarette smoking remains the dominant risk factor for COPD and COPD mortality. Despite the COPD ranking, there has been no temporal trend in COPD mortality. "COPD mortality has remained relatively stable from 2000-2007," added Dr. Holt.

"The ACCP has long recognized COPD as a significant cause of mortality and morbidity in the US," said ACCP President-Elect Darcy D. Marciniuk, MD, FCCP. "Through education, research, and communication, the ACCP is dedicated to increasing the awareness, prevention, and management of this debilitating condition."

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