COPD Risk Factors and Rurality

Chronic obstructive pulmonary disease (COPD) is a serious condition that affects the lungs and makes it hard to breathe. COPD can lead to death if not treated properly. But what are the factors that increase the risk of getting COPD? And how does where you live affect your chances of dying from COPD? These are some of the questions that this analysis tries to answer by looking at data from different counties and states in the U.S.

One of the main findings of this analysis is that people who live in rural areas are more likely to die from COPD than people who live in urban areas. From 2011 to 2021, the prevalence of COPD among adults remained stable overall (6.1% to 6.0%) and in most subgroups and states. However, the prevalence increased among adults aged ≥75 years, those living in rural areas, and those who ever smoked (Liu et al, 2023). In fact, in 2021, rural areas had a higher COPD incidence rate when compared to urban areas. This gap has been widening over time, especially in the South, where rural areas are getting worse while urban areas are improving. The Northeast and Midwest are also improving, while the West is staying the same (Yaemsiri et al., 2019).

Another important finding is that smoking is probably the biggest risk factor for COPD. Smoking rates are higher in rural areas than in urban areas, which partly explains why rural areas have more COPD deaths. Other factors that can increase the risk of COPD are air pollution, aging, poverty, nutrition, and lack of health insurance and health care access (Ruvuna and Sood 2020).

This analysis shows that COPD is a major public health problem that affects different regions and populations differently. It also suggests that reducing smoking and improving health care access and quality could help prevent and treat COPD and save lives. By understanding the causes and consequences of COPD, we can take action to improve the health and well-being of our communities.

This data is also available as an Excel spreadsheet.

COPDRiskFactors2024.xlsx (492.43 KB)

Data Sources
Data Definitions

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.

Centers for Disease Control and Prevention (CDC) PLACES Data (data released 2024)
County Health Ranking s (data released 2024)

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

FIPS: The federal information processing standard (FIPS) code for the geographic location.

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.

Uninsured Rate: The estimated number of individuals in the county under age 65 without health insurance. Data is from the Small Area Health Insurance Estimates (SAHIE) Program from 2021.

Children in Poverty Rate: The percentage of children under age 18 living in poverty. Poverty status is defined by family; either everyone in the family is in poverty or no one in the family is in poverty. Data is from the Small Area Income Poverty Estimates (SAIPE) in 2022.

Premature Age-Adjusted Mortality per 100,000: Number of deaths among residents under age 75 per 100,000 population (age-adjusted). The reporting period for this measure is 2019 through 2021 from CDC WONDER mortality data.

Child Mortality: Number of deaths among residents under age 18 per 100,000 population. The 2024 County Health Rankings used data from 2018-2021 for this measure.

Infant Mortality: Number of infant deaths (within one year) per 1,000 live births. The 2024 County Health Rankings used data from 2015-2021 for this measure.

Uninsured Adults Rate: Percentage of adults under age 65 without health insurance. The 2024 County Health Rankings used data from 2021 for this measure.

Uninsured Children Rate: Percentage of children under age 19 without health insurance. The 2024 County Health Rankings used data from 2021 for this measure.

Population Size: The total number of individuals residing in the county. The data is derived from the Census Population Estimates from 2022.

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 2022.

Percent American Indian or Alaskan Native: The proportion of the county’s population that falls into the racial or ethnic category of Native American from the US Census Bureau Population Estimates from 2022.

Percent Asian: The proportion of the county’s population that falls into the racial or ethnic category of Asian from the US Census Bureau Population Estimates from 2022.

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 US Census Bureau Population Estimates from 2022.

Percent Hispanic: The proportion of the county’s population that falls into the racial or ethnic category of Hispanic from the US Census Bureau Population Estimates from 2022.

Percent White: The proportion of the county’s population that falls into the racial or ethnic category of White from the US Census Bureau Population Estimates from 2022.

% Rural: The percentage of the county population living in a census-defined rural area.

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 BRFSS survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2021.

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 BRFSS survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2021.

Percent COPD: Percentage of respondents aged ≥18 years who report ever having been told by a doctor, nurse, or other health professional that they had 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 2021.

Visits to Doctor: Percentage of respondents greater than 18 years old who report having been to a doctor for a routine checkup (e.g., a general physical exam, not an exam for a specific injury, illness, or condition) in the previous year. Data is from the BRFSS.

Population Type: The population type is determined based on the population size of a specific county. The population types include metro, nonmetro cities, and nonmetro towns. These types are adapted from the rural-urban commuting area codes (RUCA) and core-based statistical areas (CBSA) definitions of rural and urban. The population types for counties are defined as follows:

Metro - A population of 50,000 or more
Nonmetro cities - A population between 2,500 and less than 50,000
Nonmetro towns - A population of less than 2,500

Tutorial Video

In this tutorial video, we look at COPD Risk Factors and Rurality. The video guides you through how to use Tableau data analysis to compare the risk factors and geographic characteristics such as obesity rates, smoking rates, uninsured rates, race, and rurality for each county and state.