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Indicator Definitions - Chronic Obstructive Pulmonary Disease

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Emergency department visits rate for chronic obstructive pulmonary disease as any diagnosis
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Resident persons aged ≥45 years
Numerator: Number of emergency department visits with any diagnosis of  ICD-9-CM codes 490, 491, 492, 466, 496 or ICD-10-CM codes J40-44 among residents aged ≥45 years
Denominator: Midyear resident population aged ≥45 years
Measures of Frequency: Annual number of emergency department visits.  Annual emergency department visit rate — crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population,1 age categories: 45-54, 55-64, 65-74, 75-84, ≥85) with 95% confidence interval; and by demographic characteristics when feasible.
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 1,468,000 (72.0 per 10,000 U.S. civilian population) emergency department visits for a first-listed diagnosis of chronic obstructive pulmonary disease (COPD) among adults aged ≥25 years; 73.6% of these visits occurred among persons aged ≥45 years.2  Emergency department visits have not changed between 1999 and 2010.2
Significance: Public education and awareness of COPD symptoms and earlier diagnosis and treatment can slow further lung damage and improve COPD symptoms and reduce the COPD-related disability and mortality.3 Decreasing the frequency and severity of acute exacerbations of COPD will impact the rate of hospitalizations and ED visits and possibly mortality.
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population who had COPD with serious complications.
Data Resources: State Emergency Department Databases (visits that do not result in an admission) from the Healthcare Cost and Utilization Project (numerator) and population estimates from the U.S. Census Bureau or suitable alternative (denominator).
Limitations of Data Resources: Diagnoses listed on emergency department visit data might be inaccurate. Practice patterns and payment mechanisms can affect decisions by health-care providers to identify COPD as the first-listed diagnosis. Residents of one state might be hospitalized in another state and not be reflected in the first state’s hospital data set. Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Data may not be available for all states.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-12:  Reduce hospital emergency department visits for COPD.
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  3. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

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Emergency department visits rate for chronic obstructive pulmonary disease as first-listed diagnosis
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Resident persons aged ≥45 years
Numerator: Number of ED visits with a first-listed diagnosis of  ICD-9-CM codes 490, 491, 492, 466, 496 or ICD-10-CM codes J40-44 among residents aged ≥45 years
Denominator: Midyear resident population aged ≥45 years
Measures of Frequency: Annual number of emergency department visits.  Annual emergency department visit rate — crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1, age categories: 45-54, 55-64, 65-74, 75-84, ≥85) with 95% confidence interval; and by demographic characteristics when feasible.
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 1,468,000 (72.0 per 10,000 U.S. civilian population) emergency department visits for a first-listed diagnosis of chronic obstructive pulmonary disease (COPD) among adults aged ≥25 years; 73.6% of these visits occurred among persons aged ≥45 years.2  Emergency department visits have not changed between 1999 and 2010.2
Significance: Public education and awareness of COPD symptoms and earlier diagnosis and treatment can slow further lung damage and improve COPD symptoms and reduce the COPD-related disability and mortality.3 Decreasing the frequency and severity of acute exacerbations of COPD will impact the rate of hospitalizations and ED visits and possibly mortality.
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population who had COPD with serious complications.
Data Resources: State Emergency Department Databases (visits that do not result in an admission) from the Healthcare Cost and Utilization Project (numerator) and population estimates from the U.S. Census Bureau or suitable alternative (denominator).
Limitations of Data Resources: Diagnoses listed on emergency department visit data might be inaccurate. Practice patterns and payment mechanisms can affect decisions by health-care providers to identify COPD as the first-listed diagnosis. Residents of one state might be hospitalized in another state and not be reflected in the first state’s hospital data set. Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Data may not be available for all states.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-12:  Reduce hospital emergency department visits for COPD.
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  3. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

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Hospitalization for chronic obstructive pulmonary disease as any diagnosis
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Resident persons aged ≥45 years
Numerator: Hospitalizations with any diagnosis of ICD-9-CM codes 490, 491, 492, 466, 496 or ICD-10-CM codes J40-44 among residents aged ≥45 years. When possible, include hospitalizations for residents who are hospitalized in another state.
Denominator: Midyear resident population aged ≥45 years
Measures of Frequency: Annual number of hospitalizations. Annual hospitalization rate — crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population,1 age categories: 45-54, 55-64, 65-74, 75-84, ≥85) with 95% confidence interval; and by demographic characteristics when feasible.
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 699,000 (34.4 per 10,000 U.S. civilian population) hospitalizations with a first-listed diagnosis of chronic obstructive pulmonary disease (COPD) among adults aged ≥25 years; 97.5% occurred among ages ≥45 years.2  Hospitalizations for a first-listed diagnosis of COPD declined between 1999 and 2010 (p=0.018).2  Patients with COPD may be often hospitalized with pneumonia and/or cardiovascular diseases, which may be the first-listed diagnosis.
Significance: Decreasing the frequency and severity of acute exacerbations of COPD may impact the rate of hospital and emergency visits.
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population who had COPD with serious complications.  Multiple admissions for an individual patient can falsely elevate the number of persons with COPD.  State discharge records cannot identify incident (new) hospitalizations for COPD.
Data Resources: State hospital discharge data (numerator) and population estimates from the U.S. Census Bureau or suitable alternative (denominator).
Limitations of Data Resources: Diagnoses listed on hospital discharge data might be inaccurate. Practice patterns and payment mechanisms can affect decisions by health-care providers to hospitalize patients. Residents of one state might be hospitalized in another state and not be reflected in the first state’s hospital data set. Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Because state hospital discharge data are not universally available, aggregation of state data to produce nationwide estimates will be incomplete.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-11:  Reduce hospitalizations for COPD.
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.

 

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Hospitalization for chronic obstructive pulmonary disease as any diagnosis among Medicare-eligible persons aged ≥ 65 years
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Medicare-eligible resident persons aged ≥65 years
Numerator: Hospitalizations with any diagnosis of  ICD-9-CM codes 490, 491, 492, 466, 496 or ICD-10-CM codes J40-44 among Medicare-eligible resident persons aged ≥65 years
Denominator: Residents aged≥65 years who were eligible for Medicare Part A benefits on July 1 of the calendar year
Measures of Frequency: Annual number of hospitalizations. Annual hospitalization rate — crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1, age categories: 65-74, 75-84, ≥85) with 95% confidence interval; and by demographic characteristics when feasible.
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 312,654 (11.1 per 1000 Medicare enrollees) hospitalizations for a first-listed diagnosis of chronic obstructive pulmonary disease (COPD) among Medicare enrollees aged ≥65 years.2 Hospitalizations declined between 1999 and 2010 for men (p=0.022) but not for women (p=0.138).2  Patients with COPD are often hospitalized with pneumonia and/or cardiovascular diseases, which may be the first-listed diagnosis.
Significance: Decreasing the frequency and severity of acute exacerbations of COPD may impact the rate of hospital and emergency visits.
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population who had COPD with serious complications.  Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Medicare claims records cannot identify incident (new) hospitalizations for COPD.
Data Resources: Centers for Medicare and Medicaid Services (CMS) Part A claims data (numerator) and CMS estimates of the population of persons eligible for Medicare (denominator).
Limitations of Data Resources: Diagnoses listed on Medicare hospital claims might be inaccurate. Practice patterns and payment mechanisms can affect decisions by health-care providers to hospitalize patients and to identify COPD as the first-listed diagnosis.  Multiple admissions for an individual patient can falsely elevate the number of persons with COPD.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-11:  Reduce hospitalizations for chronic obstructive pulmonary disease (COPD).
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.

 

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Hospitalization for chronic obstructive pulmonary disease as first-listed diagnosis
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Resident persons aged ≥45 years
Numerator: Hospitalizations with first-listed diagnosis of ICD-9-CM codes 490, 491, 492, 466, 496 or ICD-10-CM codes J40-44 among residents aged ≥45 years. When possible, include hospitalizations for residents who are hospitalized in another state.
Denominator: Midyear resident population aged ≥45 years
Measures of Frequency: Annual number of hospitalizations. Annual hospitalization rate — crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1, age categories: 45-54, 55-64, 65-74, 75-84, ≥85)  with 95% confidence interval; and by demographic characteristics when feasible.
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 699,000 (34.4 per 10,000 U.S. civilian population) hospitalizations with a first-listed diagnosis of chronic obstructive pulmonary disease (COPD) among adults aged ≥25 years; 97.5% occurred among ages ≥45 years.2   Hospitalizations for a first-listed diagnosis of COPD declined between 1999 and 2010 (p=0.018).2
Significance: Decreasing the frequency and severity of acute exacerbations of COPD may impact the rate of hospital and emergency visits.
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population who had COPD with serious complications.  Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. State discharge records cannot identify incident (new) hospitalizations for COPD. Patients with COPD are often hospitalized with pneumonia and/or cardiovascular diseases, which may be the first-listed diagnosis.
Data Resources: State hospital discharge data (numerator) and population estimates from the U.S. Census Bureau or suitable alternative (denominator).
Limitations of Data Resources: Diagnoses listed on hospital discharge data might be inaccurate. Practice patterns and payment mechanisms could affect decisions by health-care providers to hospitalize patients. Residents of one state might be hospitalized in another state and not be reflected in the first state’s hospital data set. Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Because state hospital discharge data are not universally available, aggregation of state data to produce nationwide estimates will be incomplete.  State discharge records cannot identify incident (new) hospitalizations.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-11:  Reduce hospitalizations for COPD.
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.

 

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Hospitalization for chronic obstructive pulmonary disease as first-listed diagnosis among Medicare-eligible persons aged ≥ 65 years
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Medicare-eligible resident persons aged ≥65 years
Numerator: Hospitalizations with first-listed diagnosis of  ICD-9-CM codes 490, 491, 492, 466, 496 or ICD-10-CM codes J40-44 among Medicare-eligible resident persons aged ≥65 years
Denominator: Residents aged≥65 years who were eligible for Medicare Part A benefits on July 1 of the calendar year
Measures of Frequency: Annual number of hospitalizations. Annual hospitalization rate — crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1, age categories: 65-74, 75-84, ≥85) with 95% confidence interval; and by demographic characteristics when feasible.
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 312,654 (11.1 per 1000 Medicare enrollees) hospitalizations for a first-listed diagnosis of chronic obstructive pulmonary disease (COPD) among Medicare enrollees aged ≥65 years.2   Hospitalizations declined between 1999 and 2010 for men (p=0.022) but not for women (p=0.138).2
Significance: Decreasing the frequency and severity of acute exacerbations of COPD may impact the rate of hospital and emergency visits.
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population who had COPD with serious complications.  Multiple admissions for an individual patient can falsely elevate the number of persons with COPD. Medicare claims records cannot identify incident (new) hospitalizations for COPD.   Patients with COPD are often hospitalized with pneumonia and/or cardiovascular diseases, which may be the first-listed diagnosis.
Data Resources: Centers for Medicare and Medicaid Services (CMS) Part A claims data (numerator) and CMS estimates of the population of persons eligible for Medicare (denominator).
Limitations of Data Resources: Diagnoses listed on Medicare hospital claims might be inaccurate. Practice patterns and payment mechanisms can affect decisions by health-care providers to hospitalize patients and to report COPD as the first-listed diagnosis.  Multiple admissions for an individual patient can falsely elevate the number of persons with COPD.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-11:  Reduce hospitalizations for COPD.
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.

 

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Influenza vaccination among non-institutionalized adults aged ≥45 years with chronic obstructive pulmonary disease
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Non-institutionalized resident persons aged ≥45 years.
Numerator: Respondents aged ≥45 years who report having ever been told that they have chronic obstructive pulmonary disease (COPD), emphysema or chronic bronchitis, and who report having received influenza vaccination in the previous 12 months.
Denominator: Respondents aged ≥45 years having ever been told that they have COPD, emphysema or chronic bronchitis, and who report having received influenza vaccination in the previous 12 months or not having received influenza vaccination in the previous 12 months (excluding unknowns and refusals).
Measures of Frequency: Annual prevalence — crude, age-stratified and age-adjusted (to the 2000 U.S. Standard Population, using the direct method1) with 95% confidence interval; and by demographic characteristics when feasible.  Because of the relatively small numbers of BRFSS respondents at the state-level who have a history of COPD, 2 or 3-year averages may be needed to provide stable state-level estimates. U.S. estimates may be based on single years of data.
Time Period of Case Definition: Lifetime COPD, which includes emphysema and/or chronic bronchitis.
Previous 12 months (vaccinated).
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD; 80% were over age 45 years .2  During the 2010-2011 influenza season, 48.4% of high risk adults 18–64 years of age and 68.6% of adults ≥65 years of age received influenza vaccine.3
Significance: Influenza viruses cause respiratory tract infections that in patients with underlying lung diseases such as COPD are associated with exacerbations and excess morbidity and mortality.4
Limitations of Indicator: Respondents might not distinguish between influenza and pneumococcal (Streptococcus pneumoniae) vaccinations.  Estimates are not specific to one influenza season; influenza vaccinations reported in the past 12 months could have been received for one or more of up to three prior influenza seasons.  For further information on the surveillance of influenza vaccination coverage, please refer to: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6204a1.htm?s_cid=ss6204a1_w.  To obtain influenza vaccination coverage estimates by season, please refer to:  http://www.cdc.gov/flu/fluvaxview/.
Data Resources: Behavioral Risk Factor Surveillance System (BRFSS).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: Healthy People 2020 Objective IID-12: Increase the percentage of children and adults who are vaccinated annually against seasonal influenza. (IID-12.6 is specific for noninstitutionalized high-risk adults aged 18 to 64 years; and IID-12.7 is specific to noninstitutionalized adults aged 65 years and older). The Healthy People 2020 influenza vaccination objectives have been consolidated since the original publication of Healthy People 2020, but will continue to be monitored as part of HP2020 data reporting.  For more information, please refer to slide 3 in the following ACIP presentation: http://www.cdc.gov/vaccines/acip/meetings/downloads/slides-oct-2013/03-Influenza-Singleton.pdf, and the Healthy People 2020 web site: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=23.
Healthy People 2020 Objective OA-2:  Increase the proportion of older adults who are up to date on a core set of clinical preventive services.
Promoting Preventive Services for Adults 50-64 — Community and Clinical Partnerships:
Percent of adults who reported influenza vaccination within the past year.
Related CDI Topic Area: Immunization; Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. CDC. Interim results: state-specific seasonal influenza vaccination coverage – United States, August 2010-February 2011. MMWR 2011; 60(22):737-743. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a3.htm
  4. Wesseling G. Occasional review: Influenza in COPD: pathogenesis, prevention, and treatment. Int J Chron Obstruct Pulmon Dis 2007 March; 2(1): 5–10.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692115/

 

 

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Mortality with chronic obstructive pulmonary disease as underlying cause among adults aged ≥ 45 years
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Resident persons aged ≥45 years
Numerator: Deaths with International Classification of Diseases (ICD)-10 Code J40-J44 as underlying cause death among residents aged ≥45 years
Denominator: Midyear resident population aged ≥45 years
Measures of Frequency: Annual number of deaths.  Annual mortality rate–crude and age-adjusted death rate per 100,000 population (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age group: 45-54, 55-64, 65-74, 75-84, ≥85)
Time Period of Case Definition: Calendar year.
Background: In 2010, there were 133,575 deaths (63.1/100,000) with chronic obstructive pulmonary disease (COPD) as the underlying cause of death for U.S. adults aged ≥25 years.2 Between 1999 and 2010, COPD deaths declined for U.S. men (p=0.001) but not for women (p=0.127).2  Over 99% of deaths from COPD occur among adults aged ≥45 years.2
Significance: Elimination of tobacco use or exposure may be the most effective way to reduce COPD because almost 80% of COPD deaths are attributable to smoking.3 Other risk factors for COPD include occupational exposure, ambient air pollution, and long-term severe asthma.4 Public education and awareness of COPD symptoms and earlier diagnosis and treatment may slow further lung damage, improve COPD symptoms, and reduce COPD-related disability and mortality.5
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population mortality.  Other comorbid conditions such as cardiovascular disease may displace COPD as the underlying cause of death that is reported on the death certificate.6,7
Data Resources: Death certificate data from vital statistics agencies (numerator) and population estimates from the U.S. Census Bureau or suitable alternative (denominator).
Limitations of Data Resources: Causes of death and other variables listed on the death certificate might be inaccurate.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-10: Reduce deaths from COPD among adults.
Related CDI Topic Area: Asthma, Tobacco, Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  3. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.  MMWR 2008;57(45):1226-1228.
  4. Mannino DM.  Epidemiology and global impact of chronic obstructive pulmonary disease. Semin Respir Crit Care Med 2005;26(2):204-210.
  5. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.
  6. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple cause coding analysis.  Eur Respir J 2003;22:809-814.
  7. Jensen HH, Godtfredsen NS, Lange P, Vestbo J.  Potential misclassification of death from COPD.  Eur Resp J 2006;28:781-785.

 

 

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Mortality with chronic obstructive pulmonary disease as underlying or contributing cause among adults aged ≥ 45 years
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Resident persons aged ≥45 years
Numerator: Deaths with International Classification of Diseases (ICD)-10 Code J40-J44 as either underlying or contributing cause of death among residents aged ≥45 years
Denominator: Midyear resident population aged ≥45 years
Measures of Frequency: Annual number of deaths.  Annual mortality rate-crude and age-adjusted death rate per 100,000 population (standardized by the direct method to the year 2000 standard U.S. population1)-with 95% confidence interval; and by demographic characteristics when feasible. (age group: 45-54, 55-64, 65-74, 75-84, ≥85)
Time Period of Case Definition: Calendar year.
Background: Over 99% of deaths from chronic obstructive pulmonary disease (COPD) occur among adults aged ≥45 years.2 COPD became the third leading cause of death in 2008.3  However, other comorbid conditions such as cardiovascular disease may displace COPD as the underlying cause of death that is reported on the death certificate.4,5
Significance: Deaths from COPD may be under-estimated; therefore a much more serious public health burden may be masked. Public education and awareness of COPD symptoms and earlier diagnosis and treatment can slow further lung damage, improve COPD symptoms, and reduce COPD-related disability and mortality.6
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population mortality.
Data Resources: Death certificate data from vital statistics agencies (numerator) and population estimates from the U.S. Census Bureau or suitable alternative (denominator).
Limitations of Data Resources: Causes of death and other variables listed on the death certificate might be inaccurate.  The number of contributing causes of death listed on the death certificate might vary by person completing the death certificate and geographic region.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-10: Reduce deaths from COPD among adults.
Related CDI Topic Area: Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  3. Minino AM, Xu J, Kochanek KD.  Deaths: preliminary data for 2008.  National Vital Statistics Report 2010;59(2):1-52.
  4. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple cause coding analysis.  Eur Respir J 2003;22:809-814.
  5. Jensen HH, Godtfredsen NS, Lange P, Vestbo J.  Potential misclassification of death from COPD.  Eur Resp J 2006;28:781-785.
  6. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

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Pneumococcal vaccination among adults aged ≥45 years with chronic obstructive pulmonary disease
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: Non-institutionalized resident persons aged ≥45 years.
Numerator: Respondents aged ≥45 years who reported having ever been told that they (COPD) chronic obstructive pulmonary disease, emphysema or chronic bronchitis, and who reported ever having received pneumococcal vaccine.
Denominator: Respondents aged ≥45 years having ever been told that they have (COPD) chronic obstructive pulmonary disease, emphysema or chronic bronchitis, and who report ever having or not ever having a pneumococcal vaccination (excluding unknowns and refusals).
Measures of Frequency: Annual prevalence — crude, age-stratified and age-adjusted (to the 2000 U.S. Standard Population, using the direct method1) with 95% confidence interval; and by demographic characteristics when feasible.  Because of the relatively small numbers of BRFSS respondents at the state-level who have a history of COPD, 2 or 3-year averages may be needed to provide stable state-level estimates. U.S. estimates may be based on single years of data.
Time Period of Case Definition: Lifetime COPD, which includes emphysema and/or chronic bronchitis.
Lifetime (ever been vaccinated)
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD; 80% were over age 45 years .2  In 2012 in the U.S., pneumococcal vaccination coverage among high-risk adults aged 19–64 years was 20.0% overall; among adults aged ≥65 years, coverage was 59.9%.3
Significance: In a study conducted among a cohort of older veterans (average age: 53 years), hospitalization rates for pneumococcal pneumonia among persons with COPD were higher compared with persons in the control group.4
Limitations of Indicator: Although self-reported pneumococcal vaccination has been validated5, the reliability and validity of this measure is unknown.
Data Resources: Behavioral Risk Factor Surveillance System (BRFSS).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: Healthy People 2020 Objective IID-13:  Increase the percentage of adults who are vaccinated against pneumococcal disease.  ( IID-13.1 is specific to noninstitutionalized adults aged 65 years and older, and IID-13.2 is specific to noninstitutionalized high-risk adults aged 18 to 64 years.)
Healthy People 2020 Objective OA-2:  Increase the proportion of older adults who are up to date on a core set of clinical preventive services.
Promoting Preventive Services for Adults 50-64 — Community and Clinical Partnerships:
Percent of adults who reported current smoking, diabetes, asthma or cardiovascular disease who have ever had a pneumococcal vaccination.
Related CDI Topic Area: Immunization; Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. CDC. Noninfluenza vaccination coverage among adults – United States, 2012. MMWR 2014;63(05):95-102. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305a4.htm?s_cid=mm6305a4_e
  4. CDC. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23).  MMWR 2010;59:1102-1106.   http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm
  5. Shenson D, DiMartino D, Bolen J, Campbell M, Lu PJ, Singleton JA. Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program. Vaccine 2005;23:1015-1020. http://www.ncbi.nlm.nih.gov/pubmed/15620474#

 

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Prevalence of activity limitation among adults ≥18 with diagnosed chronic obstructive pulmonary disease
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: 1. Resident persons aged ≥18 years
2. Resident persons aged ≥45 years
Numerator: Respondents aged ≥18 years (or ≥45 years) who report any health-related activity limitation (≥1 day in previous 30 days) and ever having physician-diagnosed Chronic Obstructive Pulmonary Disease (COPD), emphysema, or chronic bronchitis.
Denominator: Respondents aged ≥18 years (or ≥45 years) who report ever having physician-diagnosed COPD, emphysema, or chronic bronchitis.
Measures of Frequency: Annual prevalence (percentage)–crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age groups: #1. 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, ≥85, and #2. 45-54, 55-64, 65-74, 75-84, ≥85 )
Time Period of Case Definition: Lifetime (ever diagnosed) with COPD, which includes emphysema and/or chronic bronchitis.
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD; 80% were over age 45 years .2  COPD is an important cause of activity limitation and disability. In the 2007-2009 BRFSS for North Carolina, 5.7% of adults aged ≥18 years reported COPD; adults with COPD were more likely to report moderate to severe disability (37.0% versus 9.1%) than adults without COPD.3
Significance: Public education and awareness of COPD symptoms and earlier diagnosis with spirometry and treatment may slow further lung damage, improve COPD symptoms, and reduce COPD-related disability and mortality.4
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population prevalence.
Data Resources: Prevalence data from Behavioral Risk Factor Surveillance System (BRFSS) (numerator) and population estimates from the U.S. Census Bureau (denominator).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-9:  Reduce activity limitations among adults with chronic obstructive pulmonary disease (COPD).
Related CDI Topic Area: Disability, Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. CDC. Chronic obstructive pulmonary disease and associated health-care resource use—North Carolina, 2007 and 2009. MMWR 2012;61(8):143-146.
  4. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

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Prevalence of activity limitation among adults ≥45 years with diagnosed chronic obstructive pulmonary disease
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: 1. Resident persons aged ≥18 years
2. Resident persons aged ≥45 years
Numerator: Respondents aged ≥18 years (or ≥45 years) who report any health-related activity limitation (≥1 day in previous 30 days) and ever having physician-diagnosed Chronic Obstructive Pulmonary Disease (COPD), emphysema, or chronic bronchitis.
Denominator: Respondents aged ≥18 years (or ≥45 years) who report ever having physician-diagnosed COPD, emphysema, or chronic bronchitis.
Measures of Frequency: Annual prevalence (percentage)–crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age groups: #1. 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, ≥85, and #2. 45-54, 55-64, 65-74, 75-84, ≥85 )
Time Period of Case Definition: Lifetime (ever diagnosed) with COPD, which includes emphysema and/or chronic bronchitis.
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD; 80% were over age 45 years .2  COPD is an important cause of activity limitation and disability. In the 2007-2009 BRFSS for North Carolina, 5.7% of adults aged ≥18 years reported COPD; adults with COPD were more likely to report moderate to severe disability (37.0% versus 9.1%) than adults without COPD.3
Significance: Public education and awareness of COPD symptoms and earlier diagnosis with spirometry and treatment may slow further lung damage, improve COPD symptoms, and reduce COPD-related disability and mortality.4
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population prevalence.
Data Resources: Prevalence data from Behavioral Risk Factor Surveillance System (BRFSS) (numerator) and population estimates from the U.S. Census Bureau (denominator).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-9:  Reduce activity limitations among adults with chronic obstructive pulmonary disease (COPD).
Related CDI Topic Area: Disability, Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. CDC. Chronic obstructive pulmonary disease and associated health-care resource use—North Carolina, 2007 and 2009. MMWR 2012;61(8):143-146.
  4. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

 

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Prevalence of chronic obstructive pulmonary disease among adults ≥ 18
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: 1. Resident persons aged ≥18 years
2. Resident persons aged ≥45 years
Numerator: Respondents aged ≥18 years (or ≥45 years) who report ever having physician-diagnosed chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis.
Denominator: Respondents aged ≥18 years (or ≥45 years) who report or do not report ever having physician-diagnosed COPD, emphysema, or chronic bronchitis (excluding refusals).
Measures of Frequency: Annual prevalence (percentage)–crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age groups: #1. 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, ≥85, and #2. 45-54, 55-64, 65-74, 75-84, ≥85 )
Time Period of Case Definition: Lifetime (ever diagnosed) with COPD, which includes emphysema and/or chronic bronchitis.
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD.2  It has been estimated that another 15 million adults  have impaired pulmonary function and COPD symptoms but are unaware of having COPD because the disease has not been diagnosed by their physician with the use of spirometry.3  Between 80-90% of identified COPD cases occur at ages ≥45 years.2,4
Significance: Elimination of tobacco use or exposure may be the most effective way to reduce COPD because almost 80% of COPD deaths are attributable to smoking.5 Other risk factors for COPD include occupational exposure, ambient air pollution, and long-term severe asthma.6 Public education and awareness of COPD symptoms and earlier diagnosis with spirometry and treatment may slow further lung damage, improve COPD symptoms, and reduce COPD-related disability and mortality.7
Limitations of Indicator: The indicator is based on being diagnosed by a physician and respondent recall of the diagnosis and may underestimate the true prevalence.
Data Resources: Prevalence data from Behavioral Risk Factor Surveillance System (BRFSS) (numerator) and population estimates from the U.S. Census Bureau (denominator).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-13: (Developmental) Increase the proportion of adults with abnormal lung function whose underlying obstructive disease has been diagnosed.
Related CDI Topic Area: Asthma, Tobacco, Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. Mannino DM, Gagnon RC, Petty TL, Lydick E.  Obstructive lung disease and low lung function in adults in the United States: data from the national health and nutrition examination survey, 1988-1994.  Arch Intern Med 2000;160:1683-1689.
  4. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  5. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.  MMWR 2008;57(45):1226-1228.
  6. Mannino DM.  Epidemiology and global impact of chronic obstructive pulmonary disease. Semin Respir Crit Care Med 2005;26(2):204-210.
  7. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

 

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Prevalence of chronic obstructive pulmonary disease among adults ≥ 45 years
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: 1. Resident persons aged ≥18 years
2. Resident persons aged ≥45 years
Numerator: Respondents aged ≥18 years (or ≥45 years) who report ever having physician-diagnosed chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis.
Denominator: Respondents aged ≥18 years (or ≥45 years) who report or do not report ever having physician-diagnosed COPD, emphysema, or chronic bronchitis (excluding refusals).
Measures of Frequency: Annual prevalence (percentage)–crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age groups: #1. 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, ≥85, and #2. 45-54, 55-64, 65-74, 75-84, ≥85 )
Time Period of Case Definition: Lifetime (ever diagnosed) with COPD, which includes emphysema and/or chronic bronchitis.
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD.2  It has been estimated that another 15 million adults  have impaired pulmonary function and COPD symptoms but are unaware of having COPD because the disease has not been diagnosed by their physician with the use of spirometry.3  Between 80-90% of identified COPD cases occur at ages ≥45 years.2,4
Significance: Elimination of tobacco use or exposure may be the most effective way to reduce COPD because almost 80% of COPD deaths are attributable to smoking.5 Other risk factors for COPD include occupational exposure, ambient air pollution, and long-term severe asthma.6 Public education and awareness of COPD symptoms and earlier diagnosis with spirometry and treatment may slow further lung damage, improve COPD symptoms, and reduce COPD-related disability and mortality.7
Limitations of Indicator: The indicator is based on being diagnosed by a physician and respondent recall of the diagnosis and may underestimate the true prevalence.
Data Resources: Prevalence data from Behavioral Risk Factor Surveillance System (BRFSS) (numerator) and population estimates from the U.S. Census Bureau (denominator).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: Healthy People 2020 Objective RD-13: (Developmental) Increase the proportion of adults with abnormal lung function whose underlying obstructive disease has been diagnosed.
Related CDI Topic Area: Asthma, Tobacco, Older Adults
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC. Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. Mannino DM, Gagnon RC, Petty TL, Lydick E.  Obstructive lung disease and low lung function in adults in the United States: data from the national health and nutrition examination survey, 1988-1994.  Arch Intern Med 2000;160:1683-1689.
  4. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  5. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.  MMWR 2008;57(45):1226-1228.
  6. Mannino DM.  Epidemiology and global impact of chronic obstructive pulmonary disease. Semin Respir Crit Care Med 2005;26(2):204-210.
  7. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.  Ann Intern Med 2011;155:179-191.

 

 

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Prevalence of current smoking among adults ≥18 with diagnosed chronic obstructive pulmonary disease
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: 1. Resident persons aged ≥18 years
2. Resident persons aged ≥45 years
Numerator: Respondents aged ≥18 years (or ≥45 years) who report being current smokers and ever having physician-diagnosed chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis.
Denominator: Respondents aged ≥18 years (or ≥45 years) who report ever having physician-diagnosed COPD, emphysema, or chronic bronchitis.
Measures of Frequency: Annual prevalence (percentage)–crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age groups: #1. 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, ≥85, and #2. 45-54, 55-64, 65-74, 75-84, ≥85 )
Time Period of Case Definition: Lifetime (ever diagnosed) with COPD, which includes emphysema and/or chronic bronchitis.
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD; 75% of these adults had a history of smoking and 39% continued to smoke despite awareness of having COPD.2   Between 80-90% of identified COPD cases occur at ages ≥45 years.2,3 About 80% of COPD deaths are attributable to tobacco use.4
Significance: Elimination of tobacco use or exposure may be the most effective way to improve COPD symptoms among persons with COPD and the most effective way to prevent most COPD cases.5,6
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population prevalence.
Data Resources: Prevalence data from Behavioral Risk Factor Surveillance System (BRFSS) and population estimates from the U.S. Census Bureau (denominator).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: None.
Related CDI Topic Area: Older Adults, Tobacco
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC.  Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  4. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.  MMWR 2008;57(45):1226-1228.
  5. Lee PN, Fry JS.  Systematic review of the evidence relating FEV1 decline to giving up smoking.  BMC Med 2010;8:84.
  6. Eisner MD, Balmes J, Yelin EH, et al.  Directly measured secondhand smoke exposure and COPD health outcomes.  BMC Pulm Med 2006;6:12.

 

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Prevalence of current smoking among adults ≥45 years with diagnosed chronic obstructive pulmonary disease
Category: Chronic Obstructive Pulmonary Disease
Demographic Group: 1. Resident persons aged ≥18 years
2. Resident persons aged ≥45 years
Numerator: Respondents aged ≥18 years (or ≥45 years) who report being current smokers and ever having physician-diagnosed chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis.
Denominator: Respondents aged ≥18 years (or ≥45 years) who report ever having physician-diagnosed COPD, emphysema, or chronic bronchitis.
Measures of Frequency: Annual prevalence (percentage)–crude and age-adjusted (standardized by the direct method to the year 2000 standard U.S. population1) with 95% confidence interval; and by demographic characteristics when feasible. (age groups: #1. 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, ≥85, and #2. 45-54, 55-64, 65-74, 75-84, ≥85 )
Time Period of Case Definition: Lifetime (ever diagnosed) with COPD, which includes emphysema and/or chronic bronchitis.
Background: In 2011, 6.3% (15 million) of adults aged ≥18 years reported that they had COPD; 75% of these adults had a history of smoking and 39% continued to smoke despite awareness of having COPD.2   Between 80-90% of identified COPD cases occur at ages ≥45 years.2,3 About 80% of COPD deaths are attributable to tobacco use.4
Significance: Elimination of tobacco use or exposure may be the most effective way to improve COPD symptoms among persons with COPD and the most effective way to prevent most COPD cases.5,6
Limitations of Indicator: Because COPD is a chronic disease, years might pass before changes in behavior or clinical practice affect population prevalence.
Data Resources: Prevalence data from Behavioral Risk Factor Surveillance System (BRFSS) and population estimates from the U.S. Census Bureau (denominator).
Limitations of Data Resources: As with all self-reported sample surveys, BRFSS data might be subject to systematic error resulting from noncoverage (e.g., on college campuses or in the military), nonresponse (e.g., refusal to participate in the survey or to answer specific questions), or measurement (e.g., social desirability or recall bias).  In an effort to address some of these potential concerns, BRFSS began including cell phone only users in the 2011 data collection.  Due to changes in sampling and weighting methodology, 2011 is a new baseline for BRFSS, and comparisons with prior year data are inappropriate.
Related Indicators or Recommendations: None.
Related CDI Topic Area: Older Adults, Tobacco
  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. http://www.cdc.gov/nchs/data/statnt/statnt20.pdf
  2. CDC.  Chronic obstructive pulmonary disease among adults—United States, 2011.  MMWR 2012;61(46):938-943.
  3. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH.  COPD Surveillance – United States, 1999-2011.  Chest 2013;144:284-305.
  4. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.  MMWR 2008;57(45):1226-1228.
  5. Lee PN, Fry JS.  Systematic review of the evidence relating FEV1 decline to giving up smoking.  BMC Med 2010;8:84.
  6. Eisner MD, Balmes J, Yelin EH, et al.  Directly measured secondhand smoke exposure and COPD health outcomes.  BMC Pulm Med 2006;6:12.

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