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Data: Trends and Patterns of Differences in Chronic Respiratory Disease Mortality Among US Counties, 1980-2014; Maps: Lazaro Gamio / Axios

Deaths from chronic respiratory disease rose by almost 30% from 1980 through 2014 in the U.S., with a large portion occurring in the Appalachia and Mississippi Valley, according to county-specific data study published Tuesday. The researchers examined the deaths of 80 million Americans, and found 4.6 million died from a chronic respiratory disease.

Biggest concern: The majority of those deaths was due to chronic obstructive pulmonary disease (COPD) in central Appalachia but can be found in other states in the southern half of the U.S. as far west as Colorado. David Mannino, who co-wrote an editorial about the study, pointed out mortality tended to occur in places where there is a high concentration of low-income, white individuals with current or historic tobacco use.

Why this matters: Chronic respiratory diseases became the fifth leading cause of death in 2015 and resulted in approximately $132 billion in health spending in 2013, the study stated. With county-level data, public health directives can be more targeted and, some experts hope, more effective in cutting death rates from the disease.

Outside observations: Michael Schivo, a pulmonary disease specialist who was not part of this study, said the rate of increased mortality is surprising due to strong public health intervention programs.

"This mortality imbalance may be due to lagging ramifications of smoking trends in middle-aged to older adults (those comprising the bulk of the population), but the data really suggest that anti-smoking interventions have not penetrated all areas of the country evenly. This has major implications for how we might change how public health interventions are allocated," Schivo said.

The numbers behind the 4.6 million deaths in that 35-year period (per 100,000 deaths):

  • 85% died from COPD (mortality rate rose 30.8%, from 34.5 in 1980 to 45.1 in 2014).
  • 10% from interstitial lung disease (ILD)and pulmonary sarcoidosis (mortality rate rose 100.5%, from 2.7 deaths in 1980 to 5.5 deaths in 2014).
  • 2% from asthma (mortality rate dropped 46.5%, from 2.2 deaths in 1980 to 1.2 deaths in 2014).
  • 1% from pneumoconiosis (mortality rate dropped 48.5%, from 0.9% in 1980 to 0.46 in 2014).
  • 1% from other chronic respiratory diseases (mortality rate rose 42.3%, from 0.51 in 1980 to 0.73 in 2014).

Where the diseases are focused:

COPD: This group includes progressive lung diseases like emphysema and chronic bronchitis, with the majority of cases found in current or past smokers in Appalachia and the Mississippi Valley. Mannino pointed out that the National Institutes of Health last year developed a COPD action plan. "This is not funded at this point," Mannino said. "[Funding] is one of the things that we hope will come about because of this type of work."

Asthma: Deaths from asthma dropped nationwide by 46.5%, but certain areas, mainly along the southern half of the Mississippi River and in Georgia and South Carolina, showed an increased burden from asthma. Mannino said the the people in this area are mostly a poor, rural, and black population."This should be a focus of public health outreach," Mannino said.

Pneumoconiosis: This includes asbestosis, coal workers' pneumoconiosis, and silicosis, all of which declined except asbestosis. Most pneumoconiosis deaths occurred in central Appalachia but there were small pockets elsewhere. One interesting thing, Mannino pointed out, is that one of the areas where silicosis rose is where fracking occurs. "Deaths from silicosis should be completely preventable" once the new protocol on silica usages is adopted, he said. The Occupational Safety and Health Administration issued a warning and a final rule in 2017 to protect workers from silica dust.

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