COPD Morbidity, Mortality Varies Widely Across the United States

A new report on the prevalence of chronic obstructive pulmonary disease (COPD) shows that there is wide variability across and within states, with West Virginia carrying the highest burden of morbidity and mortality.

During 2014-2015, 5.9% of adults (more than 15.9 million) reported having been told by their healthcare professional that they had COPD, according to research published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.

In addition, the report includes information about the relationship between COPD and several other serious comorbid diseases, such as asthma, coronary heart disease, depression, diabetes, kidney disease, myocardial infarction, and stroke. For instance, 50% of people with COPD also have depression, the study said.

The report tracks past research that suggests that socioeconomic factors, as well as smoking prevalence, play a role in the burden of COPD.

The age-adjusted prevalence ranged from 3.7% for Puerto Rico and Hawaii to 12% for West Virginia. The average score of the overall COPD burden, which ranged from 1 being best to 5 being worst, was based on 10 key metrics based on the age-adjusted percentages of:

• Adults with COPD in the state
• Smoking prevalence
• Influenza vaccination among noninstitutionalized adults 45 years and older with COPD
• Pneumococcal vaccination among noninstitutionalized adults 45 years and older with COPD
• Crude percentage of 30-day COPD hospital readmission of all admissions of Medicare fee-for-service beneficiaries
• Crude number of emergency department (ED) visits for patients with COPD per 1000 all Medicare fee-for-service beneficiaries with COPD
• Age-adjusted rate of hospitalization for COPD as first-listed diagnosis among Medicare-eligible persons 65 years and older
• Per capita medical cost for COPD by state adjusted for demographics and such medical conditions as hypertension, dyslipidemia, diabetes, cancer, arthritis, back problems, injuries, renal failure, HIV/AIDS, skin disorders, and pregnancy
• Age-adjusted number of COPD patients per a pulmonary rehabilitation program in the state
• Age-adjusted mortality rate from COPD per 100,000 adults of all ages in the state

No state received a 1 for best overall ranking. Even in states that ranked in the next best group, the report said, the burden of COPD is severe and should be studied further. It cited Colorado, which, along with 11 other states, scored between a 1.5 and a 2.5. Despite that, Colorado is in the fourth group for mortality rate and fifth for both influenza and pneumococcal vaccine.

States such as Maryland and Massachusetts rank in the first quintile for mortality rate, but come in fourth and fifth for ED visits and 30-day hospital readmissions.

Overall, the average scores are consistent with previous studies suggesting the states in Appalachia, the Mississippi delta, and parts of the South have worse COPD outcomes.

Metrics with public health and payment implications, such as vaccinations and hospital readmissions, can be examined further to identify factors associated with better performing states, said the authors, who are hoping the study will be of interest to state policy makers and public health advocates.

Data for the report came from CMS, the CDC, the Behavioral Risk Factor Surveillance System, the Medical Expenditures Panel Survey, and the American Association of Cardiovascular and Pulmonary Rehabilitation Pulmonary Rehabilitation.

Reference

Sullivan J, Pravosud V, Mannino DM, Siegel K, Choate R, Sullivan T. National and state estimates of COPD morbidity and mortality — United States, 2014-2015. Chronic Obstr Pulm Dis. 2018;5(4):324-333. doi: 10.15326/jcopdf.5.4.2018.0157.