December 4, 2022

The Silent Epidemic: Covid and the People Who Are Dying

Who is dying of Covid? People who are younger, white and Southern, according to latest numbers from the Centers for Disease Control and Prevention.

Death rates from chronic obstructive pulmonary disease increased in every county between 1999 and 2011, with some counties seeing as much as a 143 percent increase, according to an analysis of death certificates by CDC researchers that was presented at the American Thoracic Society’s International Conference this week.

And although the rates increased everywhere, they increased the most in counties that are predominantly white and among younger people.

“We’re seeing this dramatic rise in COPD deaths across the U.S.,” said Johns Hopkins University’s Patrick Breysse, an author of the study. “People should know that this is a serious condition.”

COPD is an umbrella term that includes emphysema, chronic bronchitis and other conditions affecting the airways. The results of this study are not surprising, Breysse said.

“We’ve known for years that COPD has been impacting the United States more than it ever has before,” he said. “This really confirms what the trend has been in the past.”

A Myanmar health officer checks the temperature of a child entering the Myanmar-China border crossing checkpoint in Muse, Shan State on January 31, 2020. – Myanmar airlines suspend their China flights while the World Health Organization declared a global emergency over the new coronavirus, as China reported on January 31 the death toll had climbed to 213 with nearly 10,000 infections. (Photo by Phyo Maung Maung / AFP) (Photo by PHYO MAUNG MAUNG/AFP via Getty Images)

Still, Breysse said, the findings point to a likely need for more targeted prevention efforts. It’s well known that smoking is linked to COPD, but much less appreciated are links between COPD and obesity, air pollution and occupational risk factors including exposure to chemical fumes. “It’s no longer just cigarette smoking that’s impacting COPD,” he said.

The researchers looked at data for the years 1999 to 2011, almost double the period Breysse expected to look at when they first began their investigation. That’s because of how quickly the death rates increased during those years, he said. “We were really surprised by how fast the rates were going up.”

The researchers compared county-by-county death rates to national averages. They found that the counties with the highest COPD death rates tended to be predominantly white, have a relatively small percentage of African Americans and have large percentages of people living in poverty. And since mortality rates are typically higher for blacks than whites or Hispanics, the change in COPD mortality rates between 1999 and 2011 was especially dramatic among whites.

For example, Breysse and his colleagues found that COPD death rates more than tripled over those years for white women living in rural areas on Native American reservations. That’s compared to a tripling of COPD deaths for white women of similar age and socioeconomic characteristics in urban counties.

Why COPD is increasing more among younger adults than the elderly isn’t as clear, Breysse said. One possibility is that it is related to obesity trends, since obese women are more likely than those of normal weight to develop COPD later in life, he said. Obesity rates have increased most dramatically among younger women, he noted.

The study was not able to take into account factors such as air pollution or occupational risk factors for COPD, said Breysse. But the data suggest that targeted interventions are needed in certain areas of the country and among certain populations including blacks and Hispanics, he said.