[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Original Investigation
September 26, 2017

Trends and Patterns of Differences in Chronic Respiratory Disease Mortality Among US Counties, 1980-2014

Author Affiliations
  • 1Institute for Health Metrics and Evaluation, University of Washington, Seattle
JAMA. 2017;318(12):1136-1149. doi:10.1001/jama.2017.11747
Key Points

Question  What are the spatial and temporal trends in chronic respiratory disease mortality among US counties from 1980 to 2014?

Findings  Mortality rates due to chronic respiratory diseases varied substantially among counties in all years. Between 1980 and 2014, chronic respiratory disease mortality increased by 29.7% (95% uncertainty interval, 25.5%-33.8%) overall, but this trend varied by county, sex, and chronic respiratory disease type.

Meaning  Between 1980 and 2014, there were important differences in chronic respiratory disease mortality among US counties.


Importance  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.

Design, Setting, and Participants  Validated small area estimation models were applied to deidentified 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 estimate county-level mortality rates from 1980 to 2014 for chronic respiratory diseases.

Exposure  County of residence.

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 estimates may be helpful for informing efforts to improve prevention, diagnosis, and treatment.