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Mortality from chronic respiratory diseases varies widely in USA
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Mortality from chronic respiratory diseases varies widely in USA “This study provides much more detailed information on chronic respiratory disease mortality at the county level than has previously been available”, says Murray. “It is our hope that decision makers, public health officials, and local communities will find these data useful as they seek to improve health”. Among chronic respiratory diseases in the USA, COPD causes by far the largest number of deaths—about 151 200 of 177 300 total deaths in 2014. Between 1980 and 2014, COPD mortality in US counties ranged from 9·9 to 152·3 deaths per 100 000 people. The highest rates were found in central Appalachia and in southern USA, where a higher proportion of the residents smoke. The study showed a startling gender disparity in COPD mortality. Between 1980 and 2014, COPD mortality among males decreased by 10·9%, while the rate for females rose by 107·4%. This disparity is attributed, at least in part, to smoking prevalence among females having peaked at a later time than it did in males. Since the percentage of smokers in the USA has declined in recent decades, Murray expects COPD mortality rates to decline in the short term. However, he points out that “smoking prevalence is still high in many [US] regions and there is no
www.thelancet.com/respiratory Vol 5 November 2017
guarantee that it will continue to decline nationally in the future unless efforts to reduce smoking prevalence are continued”. Between 1980 and 2014, virtually every US county had an increased mortality for interstitial lung disease and pulmonary sarcoidosis. During this period, the nation overall saw mortality for these conditions rise from 2·7 deaths per 100 000 people to 5·5 deaths per 100 000 people. In 2014, mortality due to interstitial lung disease and pulmonary sarcoidosis ranged from 2·7 deaths per 100 000 people in the least afflicted county to 14·9 deaths per 100 000 people in the most afflicted county. The gap between rates among counties in the 10th and 90th percentiles was com paratively unremarkable—2·6 deaths per 100 000 people. Tobacco use is a huge factor in chronic respiratory disease mortality, accounting for 73·4% of such deaths. Other frequent contributing factors are air pollution and jobsite exposure to respirable toxins. The authors of the JAMA article hope this study leads to increased focus on the most afflicted areas. Mannino remains hopeful that big data studies can lead to treatment that is more targeted, adding that “the first step in fixing a problem is properly identifying it”.
Published Online October 12, 2017 http://dx.doi.org/10.1016/ S2213-2600(17)30390-9 For the JAMA study see http:// jamanetwork.com/journals/ jama/article-abstract/2654821 For the editorial accompanying the study see http:// jamanetwork.com/journals/ jama/article-abstract/2654796 For more on COPD care delivery in the USA see Lancet Respir Med 2016; 4: 473–526
Ray Cavanaugh
Science Photo Library
A study published in JAMA shows a substantial difference in mortality rates from chronic respiratory diseases between counties in the USA—with some drastic differences even between counties located in the same state. According to Dr David M Mannino (University of Kentucky College of Public Health, Lexington, KY, USA), who wrote an editorial to accompany the JAMA study, there has always been a sense that chronic respiratory disease could vary radically from one county to another, but this study quantified that disparity for the first time. In 2014, there were 177 300 deaths in the USA due to chronic respiratory diseases, accounting for 6·7% of all deaths. Mortality due to chronic respiratory diseases in the USA was 52·9 deaths per 100 000 people, but this 2014 rate is less than that in 2002, the peak year, which saw 55·4 deaths per 100 000 people. “We think that the rise, peak in 2002, and then decline in mortality due to chronic respiratory diseases (particularly chronic obstructive pulmonary disease [COPD]) reflects earlier patterns in smoking prevalence due to the lag between exposure to tobacco smoke and negative health effects like COPD”, Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation at the University of Washington, USA, told The Lancet Respiratory Medicine. The JAMA study analysed records from the US Census Bureau, the Human Mortality Database, and the National Center for Health Statistics and showed that, among counties at the 90th percentile, chronic respiratory diseases caused 85·2 deaths per 100 000 people; nearly double that of counties at the 10th percentile, which had a mortality of 44·1 per 100 000 people. The most afflicted US county had a mortality of 161·0 per 100 000 people, more than 11 times the rate of the least afflicted US county, which had 14·3 deaths per 100 000 people.
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Mortality from chronic respiratory diseases varies widely in USA “This study provides much more detailed information on chronic respiratory disease mortality at the county level than has previously been available”, says Murray. “It is our hope that decision makers, public health officials, and local communities will find these data useful as they seek to improve health”. Among chronic respiratory diseases in the USA, COPD causes by far the largest number of deaths—about 151 200 of 177 300 total deaths in 2014. Between 1980 and 2014, COPD mortality in US counties ranged from 9·9 to 152·3 deaths per 100 000 people. The highest rates were found in central Appalachia and in southern USA, where a higher proportion of the residents smoke. The study showed a startling gender disparity in COPD mortality. Between 1980 and 2014, COPD mortality among males decreased by 10·9%, while the rate for females rose by 107·4%. This disparity is attributed, at least in part, to smoking prevalence among females having peaked at a later time than it did in males. Since the percentage of smokers in the USA has declined in recent decades, Murray expects COPD mortality rates to decline in the short term. However, he points out that “smoking prevalence is still high in many [US] regions and there is no
www.thelancet.com/respiratory Vol 5 November 2017
guarantee that it will continue to decline nationally in the future unless efforts to reduce smoking prevalence are continued”. Between 1980 and 2014, virtually every US county had an increased mortality for interstitial lung disease and pulmonary sarcoidosis. During this period, the nation overall saw mortality for these conditions rise from 2·7 deaths per 100 000 people to 5·5 deaths per 100 000 people. In 2014, mortality due to interstitial lung disease and pulmonary sarcoidosis ranged from 2·7 deaths per 100 000 people in the least afflicted county to 14·9 deaths per 100 000 people in the most afflicted county. The gap between rates among counties in the 10th and 90th percentiles was com paratively unremarkable—2·6 deaths per 100 000 people. Tobacco use is a huge factor in chronic respiratory disease mortality, accounting for 73·4% of such deaths. Other frequent contributing factors are air pollution and jobsite exposure to respirable toxins. The authors of the JAMA article hope this study leads to increased focus on the most afflicted areas. Mannino remains hopeful that big data studies can lead to treatment that is more targeted, adding that “the first step in fixing a problem is properly identifying it”.
Published Online October 12, 2017 http://dx.doi.org/10.1016/ S2213-2600(17)30390-9 For the JAMA study see http:// jamanetwork.com/journals/ jama/article-abstract/2654821 For the editorial accompanying the study see http:// jamanetwork.com/journals/ jama/article-abstract/2654796 For more on COPD care delivery in the USA see Lancet Respir Med 2016; 4: 473–526
Ray Cavanaugh
Science Photo Library
A study published in JAMA shows a substantial difference in mortality rates from chronic respiratory diseases between counties in the USA—with some drastic differences even between counties located in the same state. According to Dr David M Mannino (University of Kentucky College of Public Health, Lexington, KY, USA), who wrote an editorial to accompany the JAMA study, there has always been a sense that chronic respiratory disease could vary radically from one county to another, but this study quantified that disparity for the first time. In 2014, there were 177 300 deaths in the USA due to chronic respiratory diseases, accounting for 6·7% of all deaths. Mortality due to chronic respiratory diseases in the USA was 52·9 deaths per 100 000 people, but this 2014 rate is less than that in 2002, the peak year, which saw 55·4 deaths per 100 000 people. “We think that the rise, peak in 2002, and then decline in mortality due to chronic respiratory diseases (particularly chronic obstructive pulmonary disease [COPD]) reflects earlier patterns in smoking prevalence due to the lag between exposure to tobacco smoke and negative health effects like COPD”, Dr Christopher Murray, Director of the Institute for Health Metrics and Evaluation at the University of Washington, USA, told The Lancet Respiratory Medicine. The JAMA study analysed records from the US Census Bureau, the Human Mortality Database, and the National Center for Health Statistics and showed that, among counties at the 90th percentile, chronic respiratory diseases caused 85·2 deaths per 100 000 people; nearly double that of counties at the 10th percentile, which had a mortality of 44·1 per 100 000 people. The most afflicted US county had a mortality of 161·0 per 100 000 people, more than 11 times the rate of the least afflicted US county, which had 14·3 deaths per 100 000 people.
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