Trends and patterns of differences in chronic respiratory disease mortality among US counties, 1980–2014

Abstract

Chronic respiratory diseases are an important cause of death and disability in the United States.

OBJECTIVE 

To estimate age-standardized mortality rates by county from chronic respiratory diseases.

MAIN OUTCOMES AND MEASURES 

Age-standardized mortality rates by county, year, sex, and cause.

RESULTS 

A total of 4,616,711 deaths due to chronic respiratory diseases were recorded in the United States from January 1, 1980, through December 31, 2014. Nationally, the mortality rate from chronic respiratory diseases increased from 40.8 (95% uncertainty interval [UI], 39.8–41.8) deaths per 100,000 population in 1980 to a peak of 55.4 (95% UI, 54.1–56.5) deaths per 100,000 population in 2002 and then declined to 52.9 (95% UI, 51.6–54.4) deaths per 100,000 population in 2014. This overall 29.7% (95% UI, 25.5%–33.8%) increase in chronic respiratory disease mortality from 1980 to 2014 reflected increases in the mortality rate from chronic obstructive pulmonary disease (by 30.8% [95% UI, 25.2%–39.0%], from 34.5 [95% UI, 33.0–35.5] to 45.1 [95% UI, 43.7–46.9] deaths per 100,000 population), interstitial lung disease and pulmonary sarcoidosis (by 100.5% [95% UI, 5.8%–155.2%], from 2.7 [95% UI, 2.3–4.2] to 5.5 [95% UI, 3.5–6.1] deaths per 100,000 population), and all other chronic respiratory diseases (by 42.3% [95% UI, 32.4%–63.8%], from 0.51 [95% UI, 0.48–0.54] to 0.73 [95% UI, 0.69–0.78] deaths per 100,000 population). There were substantial differences in mortality rates and changes in mortality rates over time among counties, and geographic patterns differed by cause. Counties with the highest mortality rates were found primarily in central Appalachia for chronic obstructive pulmonary disease and pneumoconiosis; widely dispersed throughout the Southwest, northern Great Plains, New England, and South Atlantic for interstitial lung disease; along the southern half of the Mississippi River and in Georgia and South Carolina for asthma; and in southern states from Mississippi to South Carolina for other chronic respiratory diseases.

CONCLUSIONS AND RELEVANCE 

Despite recent declines in mortality from chronic respiratory diseases, mortality rates in 2014 remained significantly higher than in 1980. Between 1980 and 2014, there were important differences in mortality rates and changes in mortality by county, sex, and particular chronic respiratory disease type. These estimatesmay be helpful for informing efforts to improve prevention, diagnosis, and treatment.