How these Data are Estimated

Until 2014, the number of people living with chronic obstructive pulmonary disease (COPD) was estimated based on how many answered yes to questions on the Centers for Disease Control and Prevention’s National Health Interview Survey (CDC, NHIS) asking if they had been diagnosed with either chronic bronchitis or emphysema, the two primary components of COPD. The NHIS provides nationally representative estimates for many health factors and diseases based on in-home interviews with randomly selected people. Trends and demographic differences for these two diseases are presented first before discussing results based on the addition of a new, third COPD question. We will then discuss the possible underdiagnoses of this condition.

Chronic Bronchitis

  • In 2018, 9.0 million adults, or 3.6% of those ages 18 or older, had chronic bronchitis.
  • Rates were greater among:
    • Non-Hispanic whites compared to other racial and ethnic groups
    • Women compared to men
    • Those ages 65 and older compared to younger age groups

Trends in Chronic Bronchitis by Race/Ethnicity, Sex and Age

   Non-Hispanic  
 Total (2) WhiteBlackOtherHispanic
 NumberRateNumberRateNumberRateNumberRateNumberRate
19998,847,6464.4%7,272,3194.9%805,1283.6%238,8773.1%531,3222.6%
20009,354,9824.6%7,680,1175.1%922,0454.0%186,4262.2%566,3942.7%
200111,198,6025.5%9,066,9216.1%1,193,6325.2%258,0922.9%679,9573.1%
20029,113,5814.4%7,177,9464.8%1,081,0024.6%225,0542.5%629,5792.8%
20038,560,3424.0%6,847,6494.5%924,5723.9%184,5262.1%603,5952.3%
20049,047,4814.2%7,302,1064.7%899,8363.7%184,5261.8%603,5952.5%
20058,912,3754.1%6,953,5474.5%1,074,7024.4%218,3402.2%665,7862.4%
20069,463,0824.3%7,315,0584.7%1,145,1534.5%358,8023.1%644,0692.2%
20077,604,0983.4%6,008,4493.9%843,3463.2%249,2542.0%503,0491.7%
20089,832,0894.4%7,905,6805.1%1,023,7023.9%272,0562.2%630,6512.1%
20099,901,5804.4%7,723,2764.9%1,073,3074.0%291,3692.3%819,6282.6%
20109,883,2294.3%7,635,8604.9%1,127,0514.1%242,2321.9%878,0862.7%
201110,070,8514.4%7,471,9004.7%1,332,1644.9%324,0652.4%942,7222.9%
20128,657,7763.7%6,548,0824.2%1,042,9003.7%277,5811.9%789,2132.3%
20138,940,1693.7%6,571,1324.1%1,181,4914.0%290,4561.7%897,0902.3%
20148,691,7573.6%6,432,2954.1%1,258,5514.4%355,5392.3%645,3721.8%
20159,274,3313.8%6,973,2894.4%1,223,7844.2%254,4051.5%822,8532.2%
20168,940,1693.7%6,571,1324.1%1,181,4914.0%290,4561.7%897,0902.3%
20178,567,5313.5%6,190,2703.9%1,169,7763.9%378,6962.1%828,7892.1%
20189,003,2873.6%6,495,2414.1%1,125,3353.7%387,2862.1%995,4252.4%
           
 MaleFemale18-4445-6465+
 NumberRateNumberRateNumberRateNumberRateNumberRate
19992,661,4352.8%6,186,2115.9%3,978,3443.7%2,962,0105.1%1,907,2925.9%
20003,013,6163.1%6,341,3666.0%3,876,5053.6%3,353,1765.5%2,125,3016.5%
20013,718,6473.8%7,479,9557.1%4,913,2774.5%4,073,6156.5%2,211,7106.7%
20022,891,5962.9%6,221,9855.8%3,761,2353.5%3,563,4985.5%1,788,8485.4%
20032,740,5942.7%5,819,7485.3%3,253,7282.9%3,310,9334.9%1,995,6815.8%
20042,756,7772.7%6,290,7045.6%3,483,0383.2%3,412,9694.9%2,151,4746.2%
20052,886,3442.8%6,026,0315.3%3,504,1743.2%3,543,8994.9%1,864,3025.3%
20062,912,1242.7%6,550,9585.8%3,182,0262.9%4,107,5585.5%2,173,4986.1%
20072,558,6232.4%5,045,4754.4%2,515,1412.3%3,225,6074.2%1,863,3505.2%
20083,120,9412.9%6,711,1485.8%3,486,4193.2%4,251,2145.5%2,094,4565.6%
20093,189,1612.9%6,718,4195.7%3,092,9892.8%4,411,1015.6%2,403,4906.4%
20103,399,1113.1%6,484,1185.5%3,265,4843.0%4,246,5935.3%2,371,1526.1%
20113,316,4883.0%6,754,3635.7%3,170,3622.9%4,355,8785.4%2,544,6116.4%
20123,199,3712.8%5,458,4054.5%2,721,0832.5%3,831,2394.7%2,105,4545.0%
20133,037,5942.6%5,902,5754.7%2,264,1222.0%4,202,6235.0%2,473,4245.2%
20142,993,1492.6%5,698,6084.6%2,834,7782.5%3,600,0894.4%2,256,8905.0%
20153,122,6152.7%6,151,7164.9%2,528,4072.2%3,982,1924.8%2,763,7326.0%
20163,037,5942.6%5,902,5754.7%2,264,1222.0%4,202,6235.0%2,473,4245.2%
20172,556,3282.1%6,011,2034.7%2,272,2952.0%3,782,2944.5%2,512,9425.1%
20182,854,9292.4%6,148,3584.8%2,547,7432.2%3,733,8164.5%2,721,7285.3%

Source:
Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 1999-2018. Analysis by the American Lung Assocation Research and Program Services Division using SPSS software.

  • (1) Chronic Bronchitis prevalence was defined as answering "yes" to "Have you been told by a doctor or other health professional that you had chronic bronchitis in the past 12 months
  • (2) Due to rounding, numbers across may not sum up to totals.

*Non-Hispanic

  • From 1999 to 2018, chronic bronchitis rates decreased at an average of 1.5 percent per year.

Emphysema

  • In 2018, 2.0 million adults, or 1.6% of those ages 18 or older, had emphysema.
  • Rates were greater among:
    • Non-Hispanic whites compared to other racial and ethnic groups
    • Men compared to women
    • Those ages 65 and older compared to younger age groups

Trends in Emphysema by Race/Ethnicity, Sex and Age

        Non-Hispanic      
  Total (2)    White   Black   Other   Hispanic
  Number Rate   Number Rate   Number Rate   Number Rate   Number Rate
1999 2,798,963 1.4   2,539,202 1.7   117,378 0.5   52,932 0.7   89,451 0.4
2000 3,124,699 1.6   2,792,954 1.9   208,025 0.9   32,847 0.4   90,873 0.4
2001 2,983,598 1.5   2,632,331 1.8   164,628 0.7   55,941 0.6   130,698 0.6
2002 3,131,410 1.5   2,809,643 1.9   197,404 0.8   45,193 0.5   79,170 0.4
2003 3,114,666 1.5   2,798,537 1.8   193,157 0.8   43,126 0.5   79,846 0.3
2004 3,575,684 1.7   3,086,086 2.0   238,734 1.0   95,553 1.0   155,311 0.6
2005 3,791,006 1.7   3,412,355 2.2   192,838 0.8   54,026 0.5   131,787 0.5
2006 4,068,667 1.9   3,619,091 2.3   190,398 0.7   147,078 1.3   112,100 0.4
2007 3,736,000 1.7   3,131,359 2.0   217,083 0.8   125,740 1.0   261,818 0.9
2008 3,789,224 1.7   3,286,507 2.1   214,072 0.8   97,161 0.8   191,484 0.6
2009 4,895,246 2.2   4,232,303 2.7   357,281 1.3   106,044 0.8   199,618 0.6
2010 4,313,991 2.0   3,644,268 2.3   290,143 1.1   148,228 1.2   231,352 0.7
2011 4,680,381 2.0   3,780,946 2.4   489,434 1.8   178,285 1.3   231,716 0.7
2012 4,108,479 1.7   3,508,081 2.2   341,593 1.2   80,765 0.6   178,040 0.5
2013 3,831,063 1.6   3,221,780 2.0   342,232 1.2   94,507 0.6   172,544 0.5
2014 3,399,869 1.4   2,764,697 1.7   295,010 1.0   102,904 0.7   237,258 0.6
2015 3,515,092 1.5   2,991,855 1.9   291,947 1.0   95,685 0.6   135,605 0.4
2016 3,417,624 1.4   2,783,153 1.7   246,033 0.8   146,106 0.8   242,332 0.6
2017 4,313,991 2.0   3,644,268 2.3   290,143 1.1   148,228 1.2   231,352 0.7
2018 3,779,970 1.5   3,028,141 1.9   318,024 1.0   124,408 0.7   309,397 0.8
                             
  Male   Female   18-44   45-64   65+
  Number Rate   Number Rate   Number Rate   Number Rate   Number Rate
1999 1,637,536 1.7   1,161,367 1.1   224,033   0.2 *   936,939 1.6   1,637,991 5.0
2000 1,690,500 1.8   1,434,199 1.4   256,030   0.2 *   1,141,600 1.9   1,727,069 5.3
2001 1,678,868 1.7   1,304,730 1.2   200,259   0.2 *   1,099,638 1.8   1,683,701 5.1
2002 1,821,630 1.8   1,309,780 1.2   287,302   0.3 *   1,271,992 2.0   1,572,116 4.8
2003 1,701,065 1.7   1,413,601 1.3   154,649   0.1 *   1,261,139 1.9   1,698,878 5.0
2004 1,871,241 1.8   1,704,443 1.5   309,071   0.3 *   1,393,431 2.0   1,873,182 5.4
2005 2,060,742 2.0   1,730,264 1.5   340,694 0.3   1,429,606 2.0   2,020,706 5.8
2006 2,481,386 2.3   1,587,281 1.4   290,075 0.3   1,764,620 2.4   2,013,972 5.7
2007 2,017,689 1.9   1,718,311 1.5   226,384 0.2   1,765,325 2.3   1,744,291 4.8
2008 1,769,048 1.6   2,020,176 1.7   222,120 0.2   1,572,766 2.0   1,994,338 5.4
2009 2,578,428 2.4   2,316,818 2.0   369,226 0.3   2,064,627 2.6   2,461,393 6.5
2010 2,247,665 2.0   2,066,326 1.7   360,739 0.3   1,703,187 2.1   2,250,065 5.8
2011 2,128,540 1.9   2,551,841 2.1   365,033 0.3   2,146,121 2.7   2,169,227 5.5
2012 2,293,022 2.0   1,815,457 1.5   292,037 0.3   1,852,778 2.3   1,963,664 4.7
2013 2,093,860 1.8   1,737,203 1.4   220,492 0.2   1,668,645 2.0   1,941,926 4.5
2014 1,622,655 1.4   1,777,214 1.4   98,071 0.1   1,510,560 1.8   1,791,238 4.0
2015 1,891,569 1.6   1,623,523 1.3   194,139 0.2   1,373,621 1.7   1,947,332 4.2
2016 1,871,267 1.6   1,652,779 1.3   178,910 0.2   1,527,235 1.8   1,817,901 3.8
2017 1,703,221 1.4   1,714,403 1.3   130,219 0.1   1,441,855 1.7   1,845,550 3.7
2018 1,970,037 1.6   1,809,933 1.4   249,791 0.2   1,348,951 1.6   2,181,228 4.2

Sources:
Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 1999-2018. Analysis by the American Lung Assocation Research and Program Services Division using SPSS software.

  • (1) Emphysema prevalence was defined as answering yes to"Have you EVER been told by a doctor or other health professional that you had emphysema?"
  • (2) Due to rounding, numbers across may not sum up to totals.
  • * Estimate for which the numerator has a relative standard error of more than 30% and should be considered unreliable.

*Non-Hispanic

  • Historically, emphysema has been more common among men than women. However, rates have converged over the last two decades as the rate among men has decreased and the rate among females has increased.

New Question

In 2014, a third question was added to the National Health Interview Survey, which asked if a person had ever been diagnosed with COPD. This may reflect the increased use of COPD as a diagnosis on its own, with no specification of chronic bronchitis or emphysema. This is supported by the low overlap in diagnoses among the three diseases.


Overlapping Diagnoses

  • In 2018, among those reporting a diagnosis of chronic bronchitis, emphysema, or COPD:
    • 55% reported chronic bronchitis
    • 23% reported emphysema
    • 52% reported COPD
  • Of those reporting a diagnosis of COPD, 54% of respondents, did not also report a diagnosis of chronic bronchitis or emphysema.

COPD Trend

  • In 2018, 16.4 million people, or 6.6% of adults, reported a diagnosis of any type of COPD (chronic bronchitis, emphysema, or COPD).
  • The number and rate of people reported with any type of COPD was relatively stable from 2014 to 2017 before increasing in 2018.

COPD by State

  • In 2018, COPD rates among adults ranged from 4.0% in Hawaii to 15.3% in West Virginia.

COPD Prevalence Rates and Counts by State and Gender, 2018

StatePercentCountPercentCountPercentCount
 MaleFemaleTotal
Alabama8.7157,80011.7231,40010.3389,200
Alaska5.215,0006.416,7005.932,400
Arizona5.4144,6008.5237,3007.1386,900
Arkansas8.392,90011.2133,2009.8226,200
California4.2626,0005.1792,2004.61,418,300
Colorado3.883,2005.0111,4004.4194,800
Connecticut4.866,0005.885,2005.3151,300
Delaware6.624,0007.529,8007.053,800
District of Columbia4.211,3006.319,2005.330,600
Florida6.7558,1009.7861,8008.31,419,900
Georgia6.2237,2008.4350,9007.3588,100
Hawaii3.419,1004.726,1004.045,300
Idaho5.837,5005.636,7005.774,200
Illinois5.8278,3007.3371,2006.6650,800
Indiana7.6187,50010.3270,7009.0460,800
Iowa5.363,3006.477,9005.8141,400
Kansas6.570,4007.078,0006.7148,400
Kentucky11.9199,70012.3217,50012.1418,900
Louisiana7.9134,60011.7215,5009.9351,700
Maine7.740,2008.446,4008.187,700
Maryland4.499,3006.9170,8005.7270,800
Massachusetts4.3112,8005.7163,8005.1278,400
Michigan7.8294,8009.4375,8008.6670,500
Minnesota4.187,0004.6100,9004.4188,800
Mississippi8.793,90010.6126,1009.7220,000
Missouri8.0185,00010.1245,7009.1432,600
Montana5.623,3006.526,8006.050,000
Nebraska6.144,0006.547,6006.391,500
Nevada6.373,6008.399,1007.3172,600
New Hampshire7.540,2008.546,8008.087,300
New Jersey5.4183,4005.7208,6005.6392,100
New Mexico5.542,9007.157,3006.3100,300
New York5.2379,7006.4513,1005.8907,300
North Carolina6.4245,7009.7408,2008.1653,900
North Dakota5.315,7004.913,8005.129,500
Ohio7.6335,7009.3433,1008.5768,800
Oklahoma7.7112,1009.2139,7008.5251,900
Oregon6.4103,7007.3122,1006.9229,100
Pennsylvania6.5319,1007.4383,2007.1719,000
Rhode Island6.024,3007.834,4006.959,200
South Carolina7.0133,2009.3193,3008.2326,500
South Dakota5.016,5004.213,9004.630,400
Tennessee8.9225,20012.2333,00010.6559,200
Texas4.3451,5007.8842,7006.21,313,000
Utah4.246,4004.246,5004.293,100
Vermont5.914,6006.316,3006.231,100
Virginia5.6179,9007.1243,2006.4423,100
Washington4.5131,3005.6166,0005.1297,400
West Virginia14.098,20016.6121,50015.3219,700
Wisconsin5.6125,8005.0114,9005.3240,700
Wyoming6.013,5006.914,9006.428,400
United States5.57,298,9006.810,032,2006.217,406,800

Sources
Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System 2018, raw data analysed by the American Lung Association Epidemiology and Statistics Unit.

Underdiagnoses

During 2007-2010, around 8.5 million adults reported they had been diagnosed with COPD. However, this may represent an underdiagnoses as more than 18 million had evidence of impaired lung function consistent with COPD.

  • Agency for Healthcare Research and Quality. HCUPnet, Healthcare Cost and Utilization Project, 1993-2016.
  • Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance Survey, 2018. Analysis by the American Lung Association Epidemiology and Statistics Unit using SPSS software.
  • Centers for Disease Control and Prevention. National Center for Health Statistics. CDC WONDER On-line Database, compiled from Underlying Cause of Death 1999-2018, 2020.
  • Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 1999-2018. Analysis by the American Lung Association Research and Program Services Division of using SPSS software.
  • National Heart Lung and Blood Institute. Morbidity and Mortality: 2009 Chart Book on Cardiovascular, Lung and Blood Diseases.
  • Tilert T, Dillon C, Paulose-Ram R, et al. Estimating the U.S. Prevalence of Chronic Obstructive Pulmonary Disease Using Pre- and Post-Bronchodilator Spirometry: The National Health and Nutrition Examination Survey (NHANES) 2007–2010. Respiratory Research. 2013; 14(1):103.
  • United States Census Bureau. Population Estimates, 2009.
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