NCHS Data Brief ■ No. 63 ■ June 2011

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Chronic Obstructive Pulmonary Disease Among Adults

Aged 18 and Over in the United States, 1998–2009

Lara J. Akinbami, M.D.; and Xiang Liu, M.Sc.

Key findings

•	 The prevalence of chronic

obstructive pulmonary disease

(COPD) in the United States

was stable from 1998 through

2009 and has remained higher

in women than in men.

•	 COPD was more prevalent

in older age groups.

•	 COPD was more prevalent

among Puerto Rican and

non-Hispanic white adults

than among non-Hispanic

black and Mexican-American

adults, and among adults

with family income below

the poverty level (8.3%) than

among adults with income

at least 200% of the poverty

level (4.3%).

•	 Prevalence of COPD

was almost twice as high in

the East South Central U.S.

Census division (7.5%) as in

the Pacific division (3.9%).

•	 From 1999 through 2007,

COPD hospitalization rates

declined for both men and

women, but COPD death rates

declined only for men.

Chronic obstructive pulmonary disease (COPD) causes substantial morbidity

and mortality (1) and may be unrecognized in its early stages. Chronic lower

respiratory disease (CLRD), which includes both COPD and asthma, was the

third leading cause of death in the United States in 2008 (2). COPD includes

chronic bronchitis and emphysema, which both make emptying air from the

lungs progressively more difficult and can be associated with cough, mucus

production, wheezing, and breathlessness (1,3). Risk factors include primarily

cigarette smoking, but also exposure to noxious particles or gases, recurrent

infection, diet, and genetic factors (1). COPD is often preventable, but there

is no cure. Treatment can control symptoms and slow disease progression

(1). This report presents trends in COPD prevalence, hospitalization, and

death rates, and detailed recent estimates for population subgroups. Asthma

is excluded from this report because it is considered a different condition

with fully reversible symptoms, although some people may have asthma and

COPD concurrently (1,3).

Keywords: lung disease • National Health Interview Survey • National 

Hospital Discharge Survey • National Vital Statistics System

Prevalence of COPD was stable from 1998 through 2009

and was significantly higher among women than men.

NOTES: COPD is chronic obstructive pulmonary disease. Age-adjusted to the 2000 U.S. standard population. Access data table 

for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db63_tables.pdf#1.

SOURCES: CDC/NCHS, Health Data Interactive and National Health Interview Survey.

Figure 1. Prevalence of COPD among adults aged 18 and over: United States, 1998–2009 Percent

3-year period

02

4

6

8

Women

Men

All

1998–2000 2001–2003 2004–2006 2007–2009
NCHS Data Brief ■ No. 63 ■ June 2011

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•	 In 2007–2009, 5.1% (11.8 million) of adults aged 18 and over had COPD—a rate that was

stable from 1998 through 2009.

•	 For each 3-year period from 1998 through 2009, women had higher COPD prevalence than

men. For 2007–2009, 6.1% of women (7.4 million) had COPD compared with 4.1% of men

(4.4 million) (Figure 1).

Prevalence of COPD was higher in older age groups, and women had 

higher rates than men throughout most of the lifespan.

•	 The prevalence of COPD rose with age for both men and women throughout most of the

lifespan (i.e., across most age groups) (Figure 2).

•	 COPD prevalence was highest among women aged 65–74 (10.4%) and 75–84 (9.7%) and

among men aged 75–84 (11.2%).

•	 COPD prevalence was greater among women than men in all age groups except the two

highest age groups (75–84 and 85 and over), for which the difference was not statistically

significant.

Figure 2. Prevalence of COPD among adults aged 18 and over, by age group and sex: United States, annual average 

2007–2009

NOTES: COPD is chronic obstructive pulmonary disease. Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db63_tables.pdf#2.

SOURCES: CDC/NCHS, Health Data Interactive and National Health Interview Survey. 

0

2

4

6

8

10

12

14 Men Women

18–24 25–44 45–54 55–64 65–74 75–84 85 and over

2.0

3.0

2.0

4.1 3.9

7.5

6.4

8.7 8.3

10.4

11.2

9.7

7.2

7.8

Percent

Age group (years)

Prevalence of COPD was highest among non-Hispanic white and Puerto 

Rican adults and among adults with family income below the poverty level.

•	 Overall, Puerto Rican (6.9%) and non-Hispanic white (5.7%) adults had higher COPD

prevalence than non-Hispanic black adults (4.4%). Mexican-American adults had the lowest

COPD prevalence (2.6%) (Figure 3).
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•	 Overall, COPD prevalence decreased with increasing income levels: adults with family

income below the federal poverty level had the highest COPD prevalence (8.3%), those

at 100%–199% of the poverty level had intermediate prevalence (6.8%), and those with

income more than 200% of the poverty level had the lowest prevalence (4.3%).

•	 Within each racial and ethnic group, COPD prevalence among poor adults (those with

income less than 100% of the poverty level) was higher than for adults with income levels

above the poverty level.

Figure 3. Prevalence of COPD among adults aged 18 and over, by race/ethnicity and poverty status: United States, 

annual average 2007–2009

*Estimate does not meet standards of reliability or precision. 

†

Includes all racial and ethnic groups, including categories not shown separately in the figure. 

NOTES: COPD is chronic obstructive pulmonary disease. Age-adjusted to the 2000 U.S. standard population. Access data table for Figure 3 at: 

http://www.cdc.gov/nchs/data/databriefs/db63_tables.pdf#3. 

SOURCES: CDC/NCHS, Health Data Interactive and National Health Interview Survey.

0

3

6

9

12

15 All income groups <100% poverty level 100%–199% poverty level ≥200% poverty level

All groups Non-Hispanic white Non-Hispanic black Mexican-American Puerto Rican †

5.1

8.3

6.8

4.3

5.7

10.9

8.7

4.7 4.4

7.0

4.9

3.2

2.6

4.0

2.3 2.2

6.9

13.0

5.6

Percent

Race/ethnicity

*

COPD prevalence was higher in the East South Central division of the 

United States than in any other U.S. Census division.

•	 Prevalence of COPD differed by geographic location and was highest in the East South

Central Census division among adults aged 18 and over (7.5% in 2007–2009) (Figure 4).

•	 Other Census divisions (West South Central, East North Central, and South Atlantic) had

2007–2009 COPD prevalence levels of 5.6%–5.8%—significantly higher than those in the

New England, Middle Atlantic, and Pacific divisions (3.9%–4.3%).

COPD hospitalization rates declined for both men and women from 1999 

through 2007. COPD death rates declined for men but not women from 1999 

through 2007.

•	 COPD death rates were higher for men than women throughout the period 1999–2007,

while hospitalization rates were similar for men and women (Figure 5).
NCHS Data Brief ■ No. 63 ■ June 2011

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NOTES: COPD is chronic obstructive pulmonary disease. For definitions of Census divisions, visit: http://www.census.gov/geo/www/us_regdiv.pdf. Age-adjusted to the 

2000 U.S. standard population. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db63_tables.pdf#4.

SOURCES: CDC/NCHS, Health Data Interactive and National Health Interview Survey.

Figure 4. Prevalence of COPD among adults aged 18 and over, by U.S. Census division: United States, annual average 

2007–2009 

East South Central: 7.5%

South Atlantic: 5.8%

East North Central: 5.7%

West South Central: 5.6%

Mountain: 4.9%

West North Central: 4.8%

Middle Atlantic: 4.3%

New England: 4.0%

Pacific: 3.9%

•	 From 1999 through 2007, COPD hospitalization rates declined for both men and women.

•	 From 1999 through 2007, COPD death rates declined for men but did not change

significantly for women, thus narrowing the mortality gap between men and women.

•	 Still, in 2007, nearly 60,000 men and nearly 65,000 women died from COPD, with death

rates of 63.5 per 100,000 population for men and 46.8 per 100,000 for women.

Summary

The prevalence of COPD did not change significantly from 1998 through 2009. This pattern

follows a period (1980–1996) during which COPD prevalence increased for women but not for

men, and during which there were greater increases in COPD hospitalizations and deaths among

women compared with men (3). Increased COPD morbidity among women is believed to reflect

increased smoking rates among women beginning in the 1940s. Although smoking prevalence

remains higher in men, the gap between men and women narrowed through the 1980s (3,4). In the

more recent period presented in this report, COPD hospitalization rates were similar for men and

women and declined for both sexes over the period. Although death rates from COPD remained

lower among women overall, death rates did not change for women from 1999 through 2007,

while they decreased for men. The narrowing gap in death rates represents a continuing shift in

the relative burden of COPD to women.

For the most recent period examined (2007–2009), COPD prevalence was highest in the East

South Central Census division. Women had higher prevalence rates than men over nearly the
NCHS Data Brief ■ No. 63 ■ June 2011

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NOTES: COPD is chronic obstructive pulmonary disease. Age-adjusted to the 2000 U.S. standard population. Figure shows first-listed hospitalizations and 

underlying cause of death identified as COPD. Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db63_tables.pdf#5.

SOURCES: CDC/NCHS, Health Data Interactive, National Hospital Discharge Survey, and National Vital Statistics System.

Figure 5. Hospitalization and death rates for COPD among adults aged 18 and over: United States, 1999–2007 Death rate per 100,000 population 

Hospitalization rate per 10,000 population

Year

0

10

20

30

40

50

60

70

80

90

0

10

20

30

40

50

60

70

80

90

Hospitalizations, women

Hospitalizations, men

Deaths, women

Deaths, men

1999 2000 2001 2002 2003 2004 2005 2006 2007

entire lifespan. Prevalence was highest among Puerto Rican and non-Hispanic white adults and

among adults with family income levels below poverty.

The American Thoracic Society (ATS) updated its Standards for the Diagnosis and Management 

of Patients With COPD in 2004 (1). Primary prevention and treatment strategies include

smoking cessation and early detection and diagnosis of COPD. Healthy People 2020 objectives

(5) incorporate these prevention and treatment strategies by targeting for reduction in activity

limitations, emergency department visits, hospitalizations, and deaths from COPD, and by setting

an objective of increased diagnosis of COPD among adults with abnormal lung function.

Definitions

Chronic bronchitis: The ATS clinical definition includes a chronic productive cough for 3

months in each of two successive years in a patient in whom other causes of productive chronic

cough have been excluded. The National Health Interview Survey (NHIS) definition included

respondents who answered “yes” to the question, “During the past 12 months, have you been told

by a doctor or other health professional that you had chronic bronchitis?”

Chronic obstructive pulmonary disease (COPD): Defined by ATS as a preventable and treatable

disease state characterized by airflow limitation that is not fully reversible. The definitions used in

this report differ by data source:

Prevalence: Adheres to ATS COPD clinical guidelines (1) and CDC COPD surveillance

summary (3) definitions and includes chronic bronchitis and emphysema. NHIS respondents

who reported either or both of these conditions were considered to have COPD.
NCHS Data Brief ■ No. 63 ■ June 2011

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Hospitalization: Includes first-listed International Classification of Diseases, Ninth Revision, 

Clinical Modification (ICD–9–CM) codes 490–492 and 496 (3), which include Chronic

bronchitis; Bronchitis, not specified as acute or chronic; Emphysema; and Chronic airway

obstruction, not elsewhere classified. The first-listed diagnosis is specified as the principal

diagnosis in the discharge summary of the medical record. It is usually the main cause of

the hospitalization.

Mortality: Includes ICD–10 codes J40–J44 and J47 as the underlying cause of death, including

Bronchitis, not specified as acute or chronic; Chronic bronchitis; Unspecified chronic

bronchitis; Emphysema; Other chronic obstructive pulmonary disease; and Bronchiectasis.

Emphysema: Defined by ATS (1) as a permanent enlargement of the air spaces in the lungs, which

is accompanied by destruction of the air space walls. The NHIS definition used in the present

report included all respondents who answered “yes” to the question, “Have you ever been told by

a doctor or other health professional that you had emphysema?”

Poverty status or percentage of poverty level: Defined based on family income, family size, and

the number of children in the family, and, for families with two or fewer adults, on the age of the

adults in the family. The poverty level is based on a set of income thresholds that vary by family

size and composition. Families or individuals with income below their appropriate thresholds are

classified as below the poverty level. These thresholds are updated annually by the U.S. Census

Bureau to reflect changes in the Consumer Price Index for all urban consumers (6). Estimates by

poverty status from NHIS are based on both reported and imputed family income (7).

Data sources and methods

All estimates were obtained from the Centers for Disease Control and Prevention’s National

Center for Health Statistics (NCHS), Health Data Interactive tables (available from:

http://www.cdc.gov/nchs/hdi.htm). 

Chronic Obstructive Pulmonary Disease: U.S., 1998–2009.” First-listed hospitalization rates for

COPD were obtained from the table, “Hospital Discharges by First- and Any-listed Diagnosis:

U.S., 1990–2007.” CLRD and asthma death rates were obtained from the table “Mortality by

Underlying and Multiple Cause, Ages 18+: U.S., 1981–2007.” Asthma deaths were subtracted

from CLRD deaths to obtain COPD deaths and death rates (see definition above).

The following NCHS data sets were used to calculate estimates for the Health Data Interactive

tables:

National Health Interview Survey (NHIS) data were used to estimate COPD prevalence. NHIS

operates continuously throughout the year to collect information on the health and health care of

the civilian noninstitutionalized U.S. population. Data for this report were taken from the Sample

Adult component, which collects detailed self-reported information about health conditions for a

randomly selected adult. For more information, or to view the NHIS questionnaire, visit the NHIS

website at: http://www.cdc.gov/nchs/nhis.htm.

National Hospital Discharge Survey (NHDS) data were used to estimate hospitalizations.

NHDS collects information from a national sample of inpatient stays in nonfederal, shortstay hospitals in the United States. Patient information is collected from medical records and

automated data files and includes demographics, length of stay, diagnoses, and procedures. For

more information, visit the NHDS website at: http://www.cdc.gov/nchs/nhds.htm.
NCHS Data Brief ■ No. 63 ■ June 2011

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The National Vital Statistics System (NVSS), Mortality component 

COPD death rates. Data are based on information from all death certificates filed in the 50 states

and the District of Columbia. Mortality statistics are based on information coded by the states

and provided to NCHS through the Vital Statistics Cooperative Program, as well as on data

from copies of original certificates received by NCHS from state registration offices. For more

information, visit the NVSS Mortality website at: http://www.cdc.gov/nchs/deaths.htm.

Data from both NHIS and NHDS are based on nationally representative samples. For both

surveys, sample weights are used to produce national estimates. Data weighting procedures are

described elsewhere (8,9). Point estimates and variances for this analysis were calculated using

SUDAAN software (10) to account for the complex sample designs of NHIS and NHDS. Civilian

population estimates from the U.S. Census Bureau were used to calculate inpatient hospitalization

rates. Residential population estimates were used to calculate death rates. Age-adjusted death

rates were calculated using the direct method and the 2000 standard population.

Differences between percentages were evaluated using two-sided significance tests at the 0.05

level. Terms such as “higher than” and “less than” indicate statistically significant differences.

Terms such as “similar” and “no difference” indicate that the statistics being compared were not

significantly different. Lack of comment regarding the difference between any two statistics does

not necessarily suggest that the difference was tested and found to be not significant.

All estimates shown in this report have a relative standard error less than or equal to 30%. The

significance of trends was tested using weighted least squares regression models of the log of

each outcome and using Joinpoint software (11) to determine whether an apparent change over

time was statistically significant. The standard error for each data point was taken into account.

About the authors

Lara Akinbami and Xiang Liu are with the Centers for Disease Control and Prevention’s National

Center for Health Statistics, Office of Analysis and Epidemiology.

References

1.	 American Thoracic Society/European Respiratory Society Task Force. Standards for the

diagnosis and management of patients with COPD [online]. Version 1.2. New York: American

Thoracic Society. 2004.

2.	 Miniño AM, Xu JQ, Kochanek KD. Deaths: Preliminary data for 2008. National Vital

Statistics Reports; vol 59 no 2. Hyattsville, MD: National Center for Health Statistics. 2010.

3.	 Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary

disease surveillance—United States, 1971–2000. In: Surveillance Summaries, August 2, 2002.

MMWR 51(SS–6):1–16. 2002.

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[online]. Centers for Disease Control and Prevention, Office on Smoking and Health. 2000.

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of Health and Human Services, Office of Disease Prevention and Health Promotion.
NCHS Data Brief ■ No. 63 ■ June 2011

6.	 Poverty [online]. U.S. Census Bureau. 2011. Available from:

http://www.census.gov/hhes/www/poverty/index.html.

7.	 Schenker N, Raghunathan TE, Chiu P-L, et al. Multiple imputation

of family income and personal earnings in the National Health Interview

Survey: Methods and examples [online]. National Center for Health Statistics

and University of Michigan. 2008.

8.	 Botman SL, Moore TF, Moriarity CL, Parsons VL. Design and

estimation for the National Health Interview Survey, 1995–2004. National

Center for Health Statistics. Vital Health Stat 2(130). 2000.

9.	 Dennison C, Pokras R. Design and operation of the National Hospital

Discharge Survey: 1988 redesign. Vital Health Stat 1(39). 2000.

10. SUDAAN, release 9.1 [computer software]. Research Triangle Park, NC:

Research Triangle Institute. 2004.

11. Joinpoint Regression Program, version 3.4 [computer software].

Bethesda, MD: National Cancer Institute, National Institutes of Health. 2010.

Suggested citation

Akinbami LJ, Liu X. Chronic obstructive

pulmonary disease among adults aged 18

and over in the United States, 1998–2009.

NCHS data brief, no 63. Hyattsville, MD:

National Center for Health Statistics. 2011.

Copyright information

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the public domain and may be reproduced

or copied without permission; citation as to

source, however, is appreciated.

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Statistics

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 Director for Science

Office of Analysis and Epidemiology

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HEALTH & HUMAN SERVICES

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