Research Square · Jun 30, 2026
A Retrospective Analysis of Mortality Due to Pulmonary Heart Disease and COPD in the United States From 1999 to 2020 Using the CDC WONDER Database
By Soomro S, Khan A, Chawla S et al.
Introduction: Pulmonary heart disease and chronic obstructive pulmonary disease remained major causes of mortality, particularly in older adults, often associated with factors such as aging, lifestyle, environment and occupation. The objective of this study is to investigate trends in mortality related to pulmonary heart disease and COPD among United States (US) adults aged ≥ 65 during the years 1999–2020. Methods: This retrospective study used death certificate data from the CDC WONDER database (1999–2020), focusing on pulmonary heart disease and diseases of pulmonary circulation and chronic lower respiratory disease (International Classification of Diseases-10: I26-I28 and J40-J47) as the underlying cause of death among US adults aged 65 and over. Age-adjusted mortality rates (AAMRs) were calculated and examined using Joinpoint regression analysis to estimate the Annual Per cent Change (APC), with 95% confidence intervals and a significance threshold of P < 0.05. Trends were analyzed across demographic factors including sex, race/ethnicity (Hispanic and non-Hispanic), and 2013 urbanization, as well as geographic variables such as US Census regions and states. Results: Pulmonary heart disease and Chronic obstructive pulmonary disease caused 182,397 deaths in adults aged ≥ 65 years between 1999 and 2020, with a mean age-adjusted mortality rate (AAMR) of 19.9 per 100,000 (95% CI:19.4–20.3). Males and Females showed a comparable mean AAMR of 22.7 and 18.1, respectively. Since 1999, mortality has significantly increased among Blacks (APC: 3.25%, 95% CI: 2.39–4.48) meanwhile from 1999 to 2003, white individuals showed a significant decline in mortality (APC: -2.75; 95% CI: -5.28 to -0.14, P < 0.05), followed by a sharp increase from 2003 to 2018 (APC: 1.48; 95% CI: 1.02 to 1.94). Post-2004, a significant upward trend in mortality was observed in the CENS-R2:Midwest (APC: 0.68; 95% CI: 0.25 to 1.17), and CENS-R3 South exhibited significant increase from 2016 to 2020 (APC: 3.40; 95% CI: 1.58 to 5.26; p < 0.05). The West(CENS-R4) exhibited a significant decline from 1999 to 2005 (APC: -3.02 95% CI: -4.68 to -1.34; p < 0.05), followed by a significant increase from 2005 to 2018 (APC: 1.57; 95% CI: 1.01 to 2.15; p < 0.05).In the CENS-R1 Northeast, a significant decline was observed from 1999 to 2002 (APC: -5.25; 95% CI: -10.1 to -0.08; p < 0.05) followed by a prolonged non significant decline. State-level variation was also notable with the highest AAMRs observed in Colorado (42.9), while the lowest were reported in Louisiana (10.8). Conclusion: Mortality from Pulmonary heart disease and Chronic obstructive pulmonary disease has risen significantly across geographic and demographic groups since 2003, particularly census regions and Non hispanic origin, highlighting the need for targeted public health strategies.