Top 5 Takeaways

  1. Geographic Variation in Mortality Trends: COPD mortality rates among women did not change significantly overall from 1999 to 2019, but increased in the Midwest and small metropolitan or nonmetropolitan areas.
  2. Men’s COPD Mortality Rates: COPD mortality rates among men decreased significantly overall and across all regional and urban-rural subgroups during the same period.
  3. Urban-Rural Disparities: Disparities in COPD mortality rates between urban and rural areas became more pronounced for both men and women over the 20-year period.
  4. Sex Differences in Mortality Rates: In 2019, COPD mortality rates were higher among men compared to women, but the gap has narrowed since 1999.
  5. Need for Targeted Strategies: To reduce COPD deaths, targeted strategies that address geographic and sex-specific differences in prevention, treatment, and management are essential.

Original Article Author and Citation

Corresponding Author

Susan A. Carlson,

Suggested Citation

Carlson SA, Wheaton AG, Watson KB, Liu Y, Croft JB, Greenlund KJ. Geographic Differences in Sex-Specific Chronic Obstructive Pulmonary Disease Mortality Rate Trends Among Adults Aged ≥25 Years — United States, 1999–2019. MMWR Morb Mortal Wkly Rep 2022;71:613–618. DOI:


Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, with overall mortality rates declining. This report analyzes sex-specific trends in age-adjusted COPD mortality rates among adults aged ≥25 years from 1999 to 2019, highlighting geographic differences.


Data from the CDC National Vital Statistics System were analyzed for COPD deaths using death certificates coded with ICD-10 codes J40-J44. Age-adjusted mortality rates were calculated by sex, urban-rural status, U.S. Census Bureau region, and state using CDC WONDER and Joinpoint software.


COPD mortality rates remained stable among women but increased in the Midwest and smaller urban areas. In contrast, men’s mortality rates decreased significantly across all regions and urban-rural classifications. The study underscores the need for improved COPD management strategies, particularly in addressing sex and geographic disparities.


To continue the reduction in COPD mortality, particularly among men, and to address the increasing rates among women in specific geographic areas, targeted public health strategies are essential. These include enhancing prevention, early diagnosis, treatment, and management efforts tailored to these demographic and geographic variations.


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