COPD death-rate by State -- "just smokers"?

   

Understanding COPD locales

Geospatial mapping visualizations are relatively new for health department officials, as well as for many other disciplines.   The Center for Disease Control (CDC) has published health profile maps for several years, intended to help illustrate health issues for Americans.   Figure 1 shows smoking rates, Figure 2 shows lung cancer death-rates, and Figure 3 shows COPD death-rate incidence by state,

The top ten states for smoking prevalence, said to be the cause of up to 90% of COPD incidence, are, in order, Kentucky, West Virginia, Oklahoma, Mississippi, Missouri, Indiana, Alabama, Louisiana, Nevada, and Tennessee.   Smoking rates by state show Utah far and away the 'cleanest' state.  California and the upper Eastern seaboard are nearly smoke-free, followed by the Rocky Mountain states (except Wyoming), and the upper Midwest.  This map is CDC 2009 data.

Lung and bronchus cancers, also said to be causally related to smoking histories, are hard to treat, and invariably fatal.  There is a remarkably close correspondence between Figures 1 and 2.    Every “top ten state” of Figure 2 except Nevada is in the top quartile, along with Arkansas, Hawaii, Illinois and North Carolina.   On the other hand, the Rocky Mountain states, upper Midwest, and California all share the lowest rates, just as they do with smoking prevalence.  Figure 2 is from CDC, 2011.

COPD death-rate maps, on the other hand, Figure 3, are surprisingly uncorrelated to Lung Cancer and smoking incidences, according to CDC maps from 2008.  For example: Vermont is the top state in terms of COPD death-rate compared to all causes, yet its smoking rate is 33^rd among states.  Idaho at 2^nd for COPD death-rates, has a smoking rank of 39^th.   Top smoking states – West Virginia, Kentucky, Oklahoma, Mississippi, Missouri, Indiana, Alabama, and Louisiana in order – in COPD are respectively #’s 17, 10, 7, 33, 19, 15, 36 and 43.

InnovaScapes Institute has compared the Top Ten states for Emphysema death-rates for the decade 1960-69, and the correlation between that map and the CDC findings in 2008 are almost one for one.  Arizona, Colorado, Florida (the one outlier), Montana, Wyoming, Idaho, Vermont, Oregon, Nevada, and Kansas in that order were the top states.  At the time (and for many years thereafter), the AMA was saying that, smoking aside, emphysema is "an urban disease".  Not one of America's cities over half a million people (21 cities) were in a single state in the Top Ten.