COPD in U.S. Adults Held Steady From 2011 to 2021 — but Not for Everyone

Summary

Chronic obstructive pulmonary disease (COPD) — a group of progressive lung diseases including emphysema and chronic bronchitis — accounts for most deaths from chronic lower respiratory diseases, the sixth leading cause of death in the United States in 2021. COPD prevalence fell during 1999–2011; this CDC analysis in MMWR looks at the decade after.

Bottom line: from 2011 to 2021, age-standardized COPD prevalence among adults stayed flat — 6.1% to 6.0% — overall and in most groups and states. But it rose among adults 75 and older, people in rural areas, and people who ever smoked, widening those gaps.

How it was measured

The Behavioral Risk Factor Surveillance System (BRFSS) is a yearly telephone survey (landline and mobile) of adults 18 and older in all 50 states, DC and the territories. COPD meant answering "yes" to: has a doctor, nurse or other health professional ever told you that you had COPD, emphysema or chronic bronchitis?

• Samples: 478,788 people in 2011 and 386,439 in 2021, with complete data (median response rates 49.7% and 43.8%).
• Methods: prevalence was age-standardized to the 2000 U.S. population; trends were measured as average annual percent change (AAPC) with Joinpoint software.

Who has COPD

About 6.4% of adults (14.3 million) had COPD in 2011 and 6.5% (14.2 million) in 2021. In both years it was more common among:

• women than men;
• older adults — prevalence rose with age;
• people with less education — rising as education level fell;
• people who were unemployed, retired, homemakers or students, and especially those unable to work;
• people in less urban places — rising as counties got more rural;
• current and former smokers;
• non-Hispanic American Indian or Alaska Native and non-Hispanic multiracial or other adults, compared with non-Hispanic White adults.

It was less common among non-Hispanic Asian, Native Hawaiian or Pacific Islander, and Hispanic adults.

COPD prevalence among adults, by age, education, urban-rural status and smoking, 2011–2021. CDC.

What changed, 2011–2021

Among adults 45–64 and people in the most rural (noncore) counties, prevalence rose from 2011 to 2018, then leveled off.

By state (age-standardized):

• 2011 ranged from 3.9% (Minnesota) to 9.5% (Kentucky); 2021 from 3.0% (Hawaii) to 11.8% (West Virginia).
• Rose significantly in Louisiana (+2.4% a year).
• Fell in Hawaii (−2.5%), New Mexico (−2.4%), Maryland and Massachusetts (−2.0% each) and New York (−1.6%).
• Rose for part of the decade in Colorado (from 2014), Utah (from 2015) and West Virginia (to 2017); fell from 2013 in Arizona, DC, Washington and Wyoming.

Why

• Flat overall, consistent with COPD death rates, which did not change during 1999–2019.
• Falling among younger adults, probably because smoking — the main cause of COPD in the United States — fell fastest among them: between 2005 and 2015, current smoking dropped 36.4% among adults 18–44, versus 22.6% at 45–64 and 2.1% at 65 and older.
• Higher in rural areas, likely from persistently high rural smoking, lower quit rates and an aging rural population.
• State differences likely reflect smoking rates, high-risk occupations and industries, and access to care for screening and diagnosis.
• Not just smokers: about 25% of adults with COPD (3.8 million) said they had never smoked. Secondhand smoke and workplace and environmental exposures also cause COPD, so smoke-free places and workplace measures — awareness of harmful exposures, removing or replacing them, better ventilation — can help.

Limitations: everything was self-reported; low response rates could bias results (though a separate national survey showed the same flat trend for 2014–2018); prevalence in 2020 and 2021 matched 2019, so COVID-19 seems not to have skewed reporting; and the survey misses people in long-term care, prisons or without a phone.

What can help

The COPD National Action Plan sets out a framework for prevention, treatment and management:

• Prevention: quitting smoking, smoke-free policies, workplace interventions — including for the 25% who never smoked.
• Early diagnosis and treatment, such as medication and oxygen therapy.
• Management: pulmonary rehabilitation, caregiving, preventing flare-ups.
• Tailoring to the groups hit hardest: people 75 and older, people who have smoked, and rural residents, who have less access to lung specialists and face more tobacco use, cultural barriers, poverty and transportation problems.

Sources

Based on "Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years — United States, 2011–2021," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.