Health Outcomes
COPD Prevalence by County — US Rankings
CDC PLACES 2023 · Age-adjusted prevalence · All 3,144 US counties
Chronic obstructive pulmonary disease — emphysema or chronic bronchitis — has the strongest single-cause association with cigarette smoking of any measure in PLACES. The age-adjusted county prevalence tracks two generations of regional smoking history more than current behavior. Central Appalachia, the Ohio River Valley, parts of the rural Plains, and the southern coastal South show the highest prevalence. Some of that pattern reflects long-tail occupational exposure (coal, textile dust, agriculture) as well, which PLACES does not separately measure. The age adjustment matters here too: older counties have more lifetime smoking exposure.
How this ranking is built
Source: CDC PLACES 2023 release. Methodology: BRFSS survey responses pooled across years, fitted with a small-area statistical model, age-adjusted to the 2000 US standard population. Confidence intervals (95%) are shown for each county — wider intervals indicate more uncertainty in the modeled estimate, typically driven by smaller populations.
Lowest COPD Rates — Top 100 Counties
Counties with the lowest reported copd prevalence — these counties show the most favorable position on this measure.
Best 100 counties for COPD.
Highest COPD Rates — Bottom 100 CountiesCounties with the highest reported copd prevalence.
Worst 100 counties for COPD.
What this ranking suggests
COPD prevalence is a historical indicator: by the time it shows up in BRFSS, the underlying smoking exposure happened decades earlier. The CSMOKING ranking is the contemporary signal; the COPD ranking is the consequence. Reading the two together for the same county gives a rough sense of where the burden is going.
Methodology notes & limitations
Estimates are statistical model outputs, not direct measurements. Small counties have wider confidence intervals; treat narrow rank differences in those rows as within-noise. Counties where the underlying population is too small to support modeling are suppressed entirely (about 1% of US counties). All measures are age-adjusted to the 2000 US standard population. The PLACES dataset uses BRFSS self-reported data — self-report introduces known direction-of-bias in some measures (BMI is under-reported; binge drinking is under-reported), but the bias is roughly uniform across counties so ranking comparability is preserved. See the methodology page for full data-pipeline documentation.
Data source: CDC PLACES 2023 release. Measure ID: COPD.