COPD Risk Factors and Rurality

The purpose of this analysis is to compare the incidence of chronic obstructive pulmonary disease (COPD) related to risk factors and geographic characteristics such as obesity rates, smoking rates, uninsured rates, race, and rurality for each county and state.

For the period 2007-2017 rural death rates were higher than urban rates for the seven major causes of death analyzed including, congestive heart failure, stroke, cancer, diabetes, unintentional injury, suicide, and COPD (Yaemsiri et al., 2019). In 2017, COPD death rates were 45 percent higher in rural areas than in urban areas. In rural areas, progress towards meeting national benchmarks for COPD death rates varied greatly by the geographic region whereby the Northeast and Midwest were improving while the South was getting worse and the West was unchanged (Yaemsiri et al., 2019).

Furthermore, the prevalence of cigarette smoking among adults residing in rural counties is higher than in urban counties, making tobacco use likely a leading cause of the difference in mortality between rural and urban areas (Dooga et al., 2017). Other risk factors related to COPD include exposure to air pollutants, aging, poverty, nutrition, and poor access to health care. 

Analyzing the Data

This data represents the most current publicly available information sources that are commonly used to study health care trends. The data is derived from the Data Sources listed below and combined to support the analysis.

This data is also available in a text-based table format.

Tutorial: Using the Data

Data Sources

CDC PLACES Data (data released March, 2021)

County Health Ranking (data released 2021)

Defining the Columns

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviation of the state.

County: The name of the county. County names are listed as provided on the U.S. Census Bureau's list of 2020 FIPS Codes for Counties and County Equivalent Entities.

Geography: Based on the Core Based Statistical Areas include Metropolitan and Micropolitan Statistical Areas. 

  • Rural: areas that have a population of fewer than 10,000.
  • Metropolitan: areas that have at least one urbanized area of 50,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.
  • Micropolitan: areas that have at least one urban cluster of at least 10,000 but less than 50,000 population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.

Percent COPD: Percentage of respondents aged ≥18 years who report ever having been told by a doctor, nurse, or other health professionals that they had chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent Smoking: Percentage of respondents aged ≥18 years who report having smoked ≥100 cigarettes in their lifetime and currently smoke every day or some days. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Obesity Rate: Percentage of respondents aged ≥18 years who have a body mass index (BMI) ≥30.0 kg/m² calculated from self-reported weight and height. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent Uninsured: Percentage of people under age 65 without insurance. The data is from the Small Area Health Insurance Estimates (SAHIE) program from 2018.

Percent Asian: The proportion of the county’s population that falls into the racial or ethnic category of Asian from the U.S. Census Bureau Population Estimates from 2019.

Percent Black: The proportion of the county’s population that falls into the racial or ethnic category of Black from the U.S. Census Bureau Population Estimates from 2019.

Percent Hispanic: The proportion of the county’s population that falls into the racial or ethnic category of Hispanic from the U.S. Census Bureau Population Estimates from 20198.

Percent Native Hawaiian or Other Pacific Islander: The proportion of the county’s population that falls into the racial or ethnic category of Native Hawaiian or Other Pacific Islander from the U.S. Census Bureau Population Estimates from 2019.

Percent Native American: The proportion of the county’s population that falls into the racial or ethnic category of Native American from the U.S. Census Bureau Population Estimates from 2019.

Percent White: The proportion of the county’s population that falls into the racial or ethnic category of White from the U.S. Census Bureau Population Estimates from 2019.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,560,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.