Geographic disparities in smoking and COPD mortality

Background: The prevalence of Chronic Obstructive Pulmonary Disease (COPD) has been on the rise during the past decade. More females than males are reporting COPD. Exposure to smoking has been identified as the major underlying causal factor for this irreversible, Chronic Lower Respiratory Condition (CLRD). Places where tobacco exposure impacts various groups need to be identified for strategic intervention and prevention.  In this study we explored various geographic distribution of COPD by the impacted population

Method:  We accessed the CDC Wonder for the national and state level mortality due to COPD and BRFSS for the prevalence. We utilized a Community Market Analysis (CMA) data base and software to identify potential areas for intervention using high tobacco purchased areas over- layered with the low tobacco cessation product use. The analysis illustrated the likelihood of potential behavioral areas to target.

Results: The CLRD deaths is the third leading causes of death nationally of which COPD mortality makes up 97% of it.  The COPD Mortality rate has been declining among males, but increasing among females steadily since 1999. The COPD mortality rate increases exponentially with aging population. This could be explained by the fact that the COPD latency is between 20-30 years, particularly among female population. There is an inverse relationship between household income and education and the prevalence of COPD. Could this be due a higher prevalence of smoking rate among lower income families and their more frequent exposure to job related environmental contaminants?  Geographic distribution of COPD mortality, morbidity and tobacco exposure appeared to follow certain pattern: more urban areas with higher population density, more economical deprived census tracts and counties with higher rate of less than high school education.

Conclusion: Using various choropleth maps to illustrate geo-differences in average annual tobacco product expenditure per household has assisted us to identify the geo-referenced area for intervention potential. The total tobacco products expenditure by state and sub-jurisdictional area obtained from a CMA pointes our attention to areas of the country with higher disparities in COPD mortality.  A series of the potential vs. positional report of number of packs of cigarette use per week and tobacco cessation product use analysis illustrated the likelihood of potential behavior of target area. It is our hope to help those areas where we have families consuming more tobacco products but low tobacco cessation products to increase our state supported Quitline registration.