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Chronic respiratory disease deaths up almost 30% since 1980

The death rate from chronic respiratory diseases increased by nearly 30% in the United States between 1980 and 2014, although these trends varied based on county of residence, chronic respiratory disease type and gender, according to findings recently published in JAMA.

According to researchers, 6.7% of all deaths in 2015 were attributable to chronic respiratory diseases such as COPD, interstitial lung disease and pulmonary sarcoidosis, asthma, and pneumoconiosis. The diseases were also responsible for approximately $132 billion in personal health expenditures in 2013.

“Geographically precise annual estimates of chronic respiratory disease mortality by type would facilitate a more complete understanding of regional and temporal variation in chronic respiratory disease mortality rates and may be useful for clinicians and policy makers interested in reducing geographic disparities and the health and financial burdens of chronic respiratory diseases overall,” Laura Dwyer-Lindgren, MPH, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and colleagues wrote.

To gather more data, researchers applied validated small area estimation models to deidentified death records from the National Center for Health Statistics and population counts from the Human Mortality Database, National Center for Health Statistics, and U.S. Census Bureau. Researchers used the data to estimate county-level mortality rates from chronic respiratory diseases from 1980 to 2014.

Overall, more than 4.6 million deaths due to chronic respiratory diseases were reported.

Dwyer-Lindgren and colleagues found that 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; the mortality rate then declined to 52.9 (95% UI, 51.6-54.4) deaths per 100,000 population in 2014. This resulted in an overall increase of 29.7% (95% UI, 25.5-33.8) in chronic respiratory disease mortality.

Additional findings from 1980 to 2014 include:

•The mortality rate per 100,000 people from COPD increased from 34.5 (95% UI, 33-35.5) to 45.1 (95% UI, 43.7-46.9), with counties throughout the south having large increases.

•The mortality rate per 100,000 people from pulmonary sarcoidosis and interstitial lung disease increased from 2.7 (95% UI, 2.3-4.2) to 5.5 (95% UI, 3.5-6.1), with New England counties having the largest increases.

•The mortality rate per 100,000 people from asthma declined from 2.2 (95% UI, 2-2.3) to 1.2 (95% UI, 1.1-1.3), and counties with the largest declines were in southern Arizona, northern New Mexico, central Colorado and western Montana.

•The mortality rate per 100,000 people from pneumoconiosis declined from 0.9 (95% UI, 0.8-1) to 0.46 (95% UI, 0.43-0.51), which was attributed in part to decreases in coal workers being diagnosed with this condition.

•The mortality rate per 100,000 people from all other chronic respiratory diseases increased from 0.51 (95% UI, 0.48-0.54) to 0.73 (95% UI, 0.69-0.78), with counties in northern Maine and Utah, southern Idaho, western Oregon and northwestern California having the largest increases.

In an accompanying editorial, David M. Mannino, MD and Wayne T. Sanderson, PhD, both of the department of preventive medicine of environmental health at the University of Kentucky College of Public Health, Lexington, referenced ordinances that limit smoking, new approaches for treating asthma, and other such initiatives as playing a role in the study’s results. They also suggested ways to reverse the upward trends.

“For example, pneumoconioses should be nearly completely preventable by occupational safety measures, and these data highlight areas where efforts need to improve,” they wrote. “For asthma, these data demonstrate success in reducing mortality over 35 years in most, but not all, parts of the country; future success will require focusing interventions in the counties that have lagged behind in the overall mortality decrease. For idiopathic interstitial lung diseases, including pulmonary sarcoidosis, for which mortality is increasing, further research into pathogenetic mechanisms will be essential to lead to breakthroughs in prevention and treatment.”

Mannino and Sanderson added that for COPD, “the high and increasing mortality rate poses a particularly pressing challenge that can be met only by major investments in both prevention — including elimination of smoking and harmful occupational exposures, as well as research into early life factors leading to COPD in later life — and the development of disease-modifying treatments to prevent progression to disability and death.” – by Janel Miller

Disclosures: Mannino reports serving as a consultant for Amgen, AstraZeneca, Boehringer Ingelheim, Forest, GlaxoSmithKline, Merck, Novartis and Sunovion; receiving grant funding from Boehringer Ingelheim, Forest, GlaxoSmithKline, Novartis and Pfizer; receiving compensation from UpToDate; serving as an expert in tobacco-related cases for Schlesinger Law Firm; and serving as chief scientific officer of the COPD Foundation. The other authors report no relevant financial disclosures.