U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS Data Brief ■ No. 256 ■ September 2016

COPD-related Mortality by Sex and Race Among Adults 

Aged 25 and Over: United States, 2000–2014

Hanyu Ni, Ph.D., and Jiaquan Xu, M.D.

Key findings 

Data from the National 

Vital Statistics System, 

Mortality

● From 2000 through 2014, 

the age-adjusted rate for 

chronic obstructive pulmonary 

disease (COPD)-related deaths 

decreased 22.5% for men and 

3.8% for women aged 25 and 

over.

● Between 2000 and 2014, 

the COPD-related death rate 

decreased for both men and 

women aged 65–84 and for 

men aged 85 and over. The rate 

increased for both men and 

women aged 45–64 and for 

women aged 85 and over.

● The age-adjusted death 

rate declined for white men 

but remained stable for white 

women from 2000 through 

2014.

● The age-adjusted death rate 

declined for black men but 

increased for black women 

from 2000 through 2014. 

● The major underlying causes 

of death for COPD-related 

deaths were COPD, heart 

disease, and cancer for both 

men and women.

Chronic obstructive pulmonary disease or COPD (chronic bronchitis and 

emphysema) is a major component of chronic lower respiratory disease (CLRD). 

CLRD has been the third leading cause of death since 2008 (1). Based on the 

underlying cause of death, the COPD death rate declined for men but increased 

for women from 2000 through 2011 (2,3). The burden of COPD mortality based 

on the underlying cause of death may be underestimated (4–6). Using data from 

the multiple causes-of-death files, this report describes COPD-related mortality 

from 2000 through 2014 by selected race and age groups for men and women 

aged 25 and over. COPD was identified as those with COPD reported anywhere 

on the death certificate, either as an underlying or a contributing cause of death.

Keywords: death rate • National Vital Statistics System

The age-adjusted rate for COPD-related deaths declined more 

rapidly for men than for women from 2000 through 2014. 

Figure 1. Crude and age-adjusted rates for COPD-related deaths for adults aged 25 and over, by 

sex: United States, 2000–2014

1

Statistically significant decrease in age-adjusted COPD-related death rate from 2000 through 2014 (p < 0.05). 2

Statistically significant decrease in crude COPD-related death rate from 2000 through 2009 (p < 0.05). 3

Statistically significant increase in crude COPD-related death rate from 2000 through 2014 (p < 0.05).

NOTES: COPD is chronic obstructive pulmonary disease. COPD-related deaths were identified as those with COPD (ICD–10 

code J40–J44) reported anywhere on the death certificate (i.e., as an underlying or a contributing cause of death). Access data 

table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db256_table.pdf#1. 

SOURCE: NCHS, National Vital Statistics System mortality data, 2000–2014. 
NCHS Data Brief ■ No. 256 ■ September 2016

■  2  ■

● Overall, the crude rate for COPD-related deaths among adults aged 25 and over remained 

flat with 132.1 deaths per 100,000 population occurring in 2000 compared with 130.4 in 

2014 (Figure 1). The age-adjusted rate declined 12.3%, from 134.6 deaths per 100,000 

standard population in 2000 to 118.0 in 2014.

● For men aged 25 and over, the crude death rate declined from 146.4 in 2000 to 134.5 in 

2009 but remained stable afterward. The age-adjusted rate declined 22.5%, from 183.0 in 

2000 to 141.9 in 2014.

● Among women in the same age group, the crude death rate increased from 119.0 in 2000 to 

123.7 in 2014. The age-adjusted rate declined 3.8%, from 104.9 in 2000 to 100.9 in 2014.

● The age-adjusted death rate remained higher for men than for women, although the gender 

gap narrowed over time.

The COPD-related death rate increased for men and women aged 45–64 and 

for women aged 85 and over between 2000 and 2014.

● Between 2000 and 2014, the COPD-related death rate decreased 29.7% for men aged 65–84 

and 22.5% for men aged 85 and over but increased 12.8% for men aged 45–64 (Figure 2). 

 

Figure 2. COPD-related death rates for selected age groups, by sex: United States, 2000 and 2014

1

Statistically significant increase in COPD-related death rate between 2000 and 2014 (p < 0.05). 2

Statistically significant decrease in COPD-related death rate between 2000 and 2014 (p < 0.05).

NOTES: COPD is chronic obstructive pulmonary disease. COPD-related deaths were identified as those with COPD (ICD–10 code J40–J44) reported anywhere 

on the death certificate (i.e., as an underlying or a contributing cause of death). Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/

db256_table.pdf#2.

SOURCE: NCHS, National Vital Statistics System mortality data, 2000 and 2014.
NCHS Data Brief ■ No. 256 ■ September 2016

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● During the same period, the death rate decreased 16.1% for women aged 65–84 but 

increased 24.4% for women aged 45–64 and 6.3% for women aged 85 and over.

● COPD-related death rates increased with age for both men and women. 

From 2000 through 2014, the age-adjusted rate for COPD-related deaths 

declined for white men but remained stable for white women.

● Overall, the age-adjusted COPD-related death rate for white adults aged 25 and over 

declined 10.5%, from 140.3 deaths per 100,000 standard population in 2000 to 125.6 in 

2014 (Figure 3).

● For white men, the age-adjusted death rate declined 21.1%, from 187.9 in 2000 to 148.3 in 

2014.

● For white women, the rates remained similar from 2000 through 2014. 

● The death rate was higher for white men than for white women throughout the period, but 

the gender gap decreased over time.

Figure 3. Age-adjusted rate for COPD-related deaths for white adults aged 25 and over, by sex: United States, 2000-

2014

 

1

Statistically significant decrease in age-adjusted COPD-related death rate from 2000 through 2014 (p < 0.05). 2

Statistically significant difference in age-adjusted COPD-related death rates between white men and women throughout the period (p < 0.05).

NOTES: COPD is chronic obstructive pulmonary disease. COPD-related deaths were identified as those with COPD (ICD–10 code J40–J44) reported anywhere 

on the death certificate (i.e., as an underlying or a contributing cause of death). White persons may be of Hispanic or non-Hispanic origin. Access data table for 

Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db256_table.pdf#3.

SOURCE: NCHS, National Vital Statistics System mortality data, 2000–2014.
NCHS Data Brief ■ No. 256 ■ September 2016

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From 2000 through 2014, the age-adjusted rate for COPD-related deaths 

declined for black men but increased for black women. 

● Overall, the age-adjusted death rate for black adults aged 25 and over declined 11.5%, from 

98.8 deaths per 100,000 standard population in 2000 to 87.4 in 2014 (Figure 4).

● For black men, the age-adjusted death rate declined 24.3%, from 159.8 in 2000 to 121.0 in 

2014.

● For black women, the death rate increased 4.2%, from 64.1 in 2000 to 66.8 in 2014. 

● The death rate was higher for black men than for black women throughout the period, 

although the gender gap decreased over time.

Figure 4. Age-adjusted rate for COPD-related deaths for black adults aged 25 and over, by sex: United States, 

2000–2014

 

1

Statistically significant decrease in age-adjusted COPD-related death rate from 2000 through 2014 (p < 0.05). 2

Statistically significant difference in age-adjusted COPD-related death rates between black men and women from 2000 through 2014 (p < 0.05). 3

Statistically significant increase in age-adjusted COPD-related death rate from 2000 through 2014 (p < 0.05).

NOTES: COPD is chronic obstructive pulmonary disease. COPD-related deaths were identified as those with COPD (ICD–10 code J40–J44) reported anywhere 

on the death certificate (i.e., as an underlying or a contributing cause of death). Black persons may be of Hispanic or non-Hispanic origin. Access data table for 

Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db256_table.pdf#4.

SOURCE: NCHS, National Vital Statistics System mortality data, 2000–2014.
NCHS Data Brief ■ No. 256 ■ September 2016

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Approximately one-half of all COPD-related deaths had COPD as the 

underlying cause of death for both men and women in 2014.

● In 2014, COPD was the underlying cause of death for 47.7% of COPD-related deaths for 

men aged 25 and over (Figure 5). Other major underlying causes of death included heart 

disease (19.4%), cancer (15.3%), diabetes (1.7%), and unintentional injuries (1.7%).

● For women in the same age group, COPD was the underlying cause of death for 54.6% of 

COPD-related deaths occurred in 2014. Other major underlying causes of death included 

heart disease (15.5%), cancer (12.1%), unintentional injuries (1.7%), and stroke (1.6%).

Figure 5. Top five underlying causes of death for COPD-related deaths for adults aged 25 and over, by sex: United States, 

2014

 

NOTES: COPD is chronic obstructive pulmonary disease. COPD-related deaths were identified as those with COPD (ICD–10 code J40–J44) reported anywhere 

on the death certificate (i.e., as an underlying or a contributing cause of death). Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/

db256_table.pdf#5.

SOURCE: NCHS, National Vital Statistics System mortality data, 2014. 
NCHS Data Brief ■ No. 256 ■ September 2016

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Summary

This report describes COPD-related mortality for U.S. adults aged 25 and over using multiple 

causes of death. The analysis revealed a decline in the age-adjusted COPD-related death rate for 

both men and women from 2000 through 2014, but a more rapid decline was seen among men. 

These declines are consistent with declines in the prevalence of current smoking for men and 

women in the United States (7). The sex-specific trend patterns differed by selected race and age 

groups. The top three underlying causes of COPD-related deaths were COPD, heart disease, and 

cancer for both men and women. The death rate continued to be higher for men than for women, 

although the gender gap decreased further over time (3). 

The finding of a declining trend in COPD mortality for men was consistent with findings from 

previous reports based on the underlying cause of death (2,3). However, the current analysis 

in the COPD-related death rate revealed a slight decline in the death rate for women, whereas 

previous studies based on underlying cause of death indicated an increase for both white and 

black women from 2000 through 2011 (2,3). In this study, the increase in the COPD-related death 

rate was only observed among black women.

Because COPD is the underlying cause of death for approximately one-half of all COPD-related 

deaths, the rate based on multiple cause of death is roughly twice as high as the rate based on the 

underlying cause of death. Using the multiple causes-of-death data, this report goes beyond the 

underlying cause and provides a more complete picture of mortality associated with COPD.

Definitions

Cause-of-death classification: Medical information, including injury diagnoses and external 

causes of injury, entered on death certificates filed in the United States, classified and coded 

in accordance with the International Statistical Classification of Disease and Related Health 

Problems, Tenth Revision (ICD–10) (8).

Underlying and multiple causes of death: Underlying cause of death is defined by the World 

Health Organization as “the disease or injury which initiated the train of events leading directly 

to death, or the circumstances of the accident or violence which produce the fatal injury” (7). 

Multiple causes of death include not only the underlying cause but also the immediate cause of 

death and all other intermediate and contributory conditions reported by the certifying physicians.

COPD-related death: All death records with COPD reported on the death certificate (any mention 

of COPD), either as an underlying or a contributing cause. These deaths were identified in the 

multiple cause-of-death files as those with ICD–10 code J40–J44 in the record axis fields.

Data source and methods

This report analyzed the multiple cause-of-death mortality files from the National Vital Statistics 

System from 2000 through 2014. The direct standardization method was used to calculate 

age-adjusted death rates, based on the projected year 2000 standard population, using age groups 

with 10-year intervals. Terms such as “higher than” or “lower than” indicate that the estimates 

being compared are statistically significant. Trends in death rates were evaluated using the 

Joinpoint Regression Program (9). The comparisons of rates and percentages are based on the 

two-tailed z-test at the 0.05 level. 
NCHS Data Brief ■ No. 256 ■ September 2016

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About the authors

Hanyu Ni and Jiaquan Xu are with the National Center for Health Statistics, Division of Vital 

Statistics.

References

1. Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital 

statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016.

2. Ma J, Ward EM, Siegel RL, Jemal A. Temporal trends in mortality in the United States, 

1969–2013. JAMA 314(16):1731–9. 2015.

3. Ford ES. Trends in mortality from COPD among adults in the United States. Chest 148(4):

962–70. 2015.

4. Fuhrman C, Jougla E, Nicolau J, Eilstein D, Delmas MC. Deaths from chronic obstructive 

pulmonary disease in France, 1979–2002: A multiple cause analysis. Thorax 61(11):930–4. 2006.

5. Hughes TS, Muldoon SB, Tollerud DJ. Underestimation of mortality due to chronic 

obstructive pulmonary disease (COPD) in Kentucky. J Ky Med Assoc 104(8):331–9. 2006.

6. Faustini A, Marino C, D’Ovidio M, Perucci CA. The concurrent COPD mortality doubles the 

mortality estimate from COPD as underlying cause in Lazio, Italy. Respir Med 101(9):1988–93. 

2007. 

7. National Center for Health Statistics. Health, United States, 2015: With special feature on 

racial and ethnic health disparities. Hyattsville, MD. 2016. 

8. WHO. International statistical classification of diseases and related health problems, tenth 

revision (ICD–10). 2008 ed. Geneva, Switzerland. 2009.

9. National Cancer Institute. Joinpoint Regression Program (Version 4.1.1.) [computer 

software]. 2014.
NCHS Data Brief ■ No. 256 ■ September 2016

Suggested citation

Ni H, Xu JQ. COPD-related mortality by 

sex and race among adults aged 25 and over: 

United States, 2000–2014. NCHS data brief, 

no 256. Hyattsville, MD: National Center 

for Health Statistics. 2016.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

Hanyu Ni, Ph.D., M.P.H., Associate Director 

for Science

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