Dwyer-Lindgren L, et al. - The goal of the study described in this paper was to evaluate age-standardized mortality rates by county from chronic respiratory diseases. The outcome suggests that the mortality rates in 2014 remained significantly higher than in 1980 despite recent declines in mortality from chronic respiratory diseases. Important differences were seen in mortality rates and changes in mortality by county, sex, and specific chronic respiratory disease type between 1980 and 2014. These evaluations might be useful for informing efforts to improve prevention, diagnosis, and treatment.

Methods

• Validated small area estimation models were applied to identified death records from the National Center for Health Statistics and population counts from the US Census Bureau, National Center for Health Statistics, and Human Mortality Database to assess county-level mortality rates from 1980 to 2014 for chronic respiratory diseases.

Results

• Between January 1, 1980, to December 31, 2014, a total of 4616711 deaths because of chronic respiratory diseases were recorded in the United States.
• Nationally, the mortality rate from chronic respiratory diseases increased from 40.8 (95% uncertainty interval [UI], 39.8-41.8) deaths per 100000 population in 1980 to a peak of 55.4 (95% UI, 54.1-56.5) deaths per 100000 population in 2002 and then declined to 52.9 (95% UI, 51.6-54.4) deaths per 100000 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 100000 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 100000 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 100000 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.