Women’s Health Dashboard:
Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) refers to a group of progressive lung diseases that cause damage to the lungs and airflow blockage, resulting in difficulty breathing. Chronic bronchitis irritates the bronchial tubes responsible for transporting air through the lungs, resulting in swelling and mucus buildup in the lining of the tissue. Emphysema is damage to the walls of the alveoli, which transfer oxygen and carbon dioxide between blood vessels and the lung – most individuals exhibit symptoms of both conditions. The inflammation and airway obstruction characterized in COPD often result from contributions from both bronchitis and emphysema. As COPD progresses, over time, it becomes harder to breathe and transport oxygen to the body’s tissues.

Tobacco smoke and exposure to air pollutants in the home and workplace are common factors associated with the development and progression of COPD. Cigarette smoking is an established risk factor and the leading cause of COPD [1].

The information presented below has been curated from 2018 data, unless otherwise stated. 

Disease Burden

In 2018, of the 17.5 million people with COPD in the United States, over 10 million were women [1]. 156,045 people died from COPD, making it the 3rd leading cause of death for women and the 4th leading cause of death for men [2]. While the mortality rates for men have decreased over the last 20 years, the mortality rates for women remain relatively unchanged.

Women are often diagnosed with COPD later than men, when the disease has progressed further and there are less treatment options. Researchers have also discovered that women may be more vulnerable to the effects of tobacco and other air pollutants [1]. Women have accounted for a higher percentage of emergency department treat-and-release visits compared to men (56% vs. 44%), as well as emergency department visits resulting in hospital admission (53% vs. 47%); however, they had lower 7-day (6.2 vs. 7.1 per 100,000) and 30-day (1.9 vs. 2.3 per 100,000) hospital readmission rates compared to men [3].

In 2019, total estimated medical costs attributable to COPD reached $71 billion [4]. Medical costs, including prescription drugs, hospitalizations, emergency department visits, and other health care visits varied by disease severity. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) characterizes COPD into 3 severity grades: Mild, Moderate, and Severe/Very Severe. Estimated medical costs for patients in the United States with mild COPD were highest, totaling $47 billion. However, patients with very severe COPD had the highest annual cost per-person ($6,456) [4]. That same year, studies estimated an additional $6.92 billion in indirect costs attributed to absenteeism among individuals with COPD [4].

Disease Prevalence and Mortality

COPD Prevalence* by Sex

*Among individuals 18 years and older
Source: COPD Prevalence Rates and Counts by State and Gender, 2018 [5]

COPD Prevalence by Age

Based on Behavioral Risk Factor Surveillance System, 2017
Source: Wheaton AG, et al. (2019) [6]

COPD Prevalence* by Race

Based on Behavioral Risk Factor Surveillance System, 2017
Source: Wheaton AG, et al. (2019) [6]

Download COPD Prevalence Data (2018)


Source: CDC Wonder [2]

COPD Mortality, U.S. Females, All Ages – Top 5 States

Crude Rates are expressed as the number of deaths reported for a calendar year per 100,000 persons.
Black/AA: Black or African American; Hispanic: Hispanic or Latino; API: Asian or Pacific Islander; AI/AN: American Indian or Alaska Native
N/A: Number of deaths fall below a determined cut-off value and therefore are suppressed, and a crude rate is not calculated.
*Includes Hispanic individuals of any race

COPD Mortality, U.S. Females, All Ages, by Race – Top 3 States

Black/AA: Black or African American; Hispanic: Hispanic or Latino; API: Asian or Pacific Islander; AI/AN: American Indian or Alaska Native
*Includes Hispanic individuals of any race


West Virginia and Kentucky, both regions located in the Appalachian Mountain region, exhibited the highest mortality rates attributed to COPD. Although represented in the heat map for all racial groups, most of the deaths in this region are among white women. New Mexico, Oklahoma, or Florida was among the top 3 states for COPD mortality for every racial group. Although much smaller in size compared to other states, the District of Columbia had one of the highest mortality rates for Black or African American women in the U.S.

Download the Full Data Table of COPD Mortality (2018), U.S. Females, All Ages, by Race and State

Disease Impacts and Influences

Multiple factors contribute to incidence, morbidity, and mortality for COPD and its disproportional impact on women and women’s health, including but not limited to biological sex, sociocultural influences, and insurance coverage.

Research Investment

The National Institutes of Health funded $111 million in COPD research in 2018 (0.4% of its total budget). Of the 229 research grants funded, 1 project (0.4%) focused on women’s health.*

*Women’s health focus was determined by searching the following key terms – Female, Gender, Maternal, Sex, and variations of Lactating, Pregnant, Women – in the project titles of all COPD funded grants, according to the NIH Research, Condition, and Disease Categorization (RCDC) report

Download the Full List of 2018 NIH-Funded Grants for COPD

Health Disparities

  • American Indian and Alaska Native people have the highest rates of COPD in the United States compared to all other racial/ethnic groups [7].
  • Black or African American people in the U.S. disproportionately account for early-onset COPD (occurring before 55 years of age) compared with late onset disease [7].
  • People living in rural areas in the United States have a higher prevalence of COPD compared to people living in large metropolitan cities (8% vs. 5% respectively) [7].

Disease Burden

According to the World Health Organization Global Health Estimates, in 2018, disability due to COPD significantly affected women, accounting for 2,560,395 total disability-adjusted life years (DALY) lost for all women ages 15 and older. Moreover, women 65 years and older had a higher DALY rate of 35,486 per 100,000 persons compared to younger women [8].

Insurance Coverage

There are significant financial costs associated with medical care for individuals with chronic diseases such as COPD. Health insurance access and coverage are important for assisting with the financial burden. Below is a table displaying rates of insurance coverage for the states with the 5 highest mortality rates attributed to COPD in 2018.

U.S. Health Insurance Coverage by State

Source: Kaiser Family Foundation Health Insurance Coverage of the Total Population (CPS), 2018 [9]
Uninsured: Includes individuals without health insurance and individuals who have coverage under the Indian Health Service only.
Employer: Includes individuals covered by employer-sponsored coverage either through their own job or as a dependent in the same household.
Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance.
Medicaid: Includes individuals covered by Medicaid, the Children’s Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligibles who are also covered by Medicare.
Medicare: Includes individuals covered by Medicare, Medicare Advantage, and those who have Medicare and another type of non-Medicaid coverage where Medicare is the primary payer. Excludes individuals with Medicare Part A coverage only and those covered by Medicare and Medicaid (dual eligibles).
Military: Includes individuals covered under the military or Veterans Administration.
N/A: Estimates with relative standard errors greater than 30% are not provided.

Download the Full Data Table of U.S. Health Insurance Coverage (2018), by State

Women & Tobacco Use

  • Despite a 10% decrease in smoking among women aged 18-44 from 2016 to 2018 [10], COPD is still the leading cause of death among female smokers in the U.S., ahead of lung cancer and cardiovascular diseases [11].
  • Prevalence of women smokers in West Virginia is 4x higher than California and Utah – the states with the lowest rates [10].
  • When visiting a physician, female smokers are one-third less likely to be diagnosed with COPD compared to male smokers. This same group of female smokers are less likely to be referred to a pulmonologist or for spirometry testing compared to their male counterparts [11].

Resources and References

Additional Resources


1American Lung Association. COPD Trends Brief. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief. Accessed 12 August 2022.

2United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Underlying Cause of Death by Single Race 2018-2020 on CDC WONDER Online Database, released 2021. Data are compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Data for year 2018 are compiled from the Multiple Cause of Death File 2018, Series 20, No. 2X, 2020. Accessed at https://wonder.cdc.gov/controller/saved/D76/D282F138 Accessed 5 April 2022.

3United States Department of Health and Human Services (US DHHS), Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), Weighted National Estimates from HCUP Nationwide Emergency Department Sample (NEDS), 2006–2019. Accessed at https://datatools.ahrq.gov/hcupnet. Accessed 20 September 2022.

4Zafari Z, Li S, Eakin MN, et al. Projecting Long-term Health and Economic Burden of COPD in the United States. Chest, 2021 Apr; 159(4):1400-1410.

5American Lung Association. COPD Prevalence Rates and Counts by State and Gender, 2018.  Available at: https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/data-tables/copd-prevalence-rates-by-state-gender. Accessed 6 June 2022.

6Wheaton, AG, Liu Y, Croft JB, et al. Chronic Obstructive Pulmonary Disease and Smoking Status—United States, 2017. MMWR, 2019 Jun 21;68(24):533-538.

7Ruvuna L, Sood A. Epidemiology of Chronic Obstructive Pulmonary Disease. Clin Chest Med, 2020 Sep;41(3):315-327.

8Global Health Estimates 2020: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2019. Geneva, World Health Organization; 2020.

9Kaiser Family Foundation State Health Facts. Health Insurance Coverage of the Total Population (CPS). Data Source: Census Bureau’s March Current Population Survey (CPS: Annual Social and Economic Supplements), 2017-2022. https://www.kff.org/other/state-indicator/health-insurance-coverage-of-the-total-population-cps/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed 14 June 2022.

10United Health Foundation. America’s Health Rankings: 2018 Health of Women and Children Report. Available at: https://www.americashealthrankings.org/learn/reports/2018-health-of-women-and-children-report. Accessed 7 October 2022.

11Gut-Gobert C, Cavaillès A, Dixmier A, et al. Women and COPD: Do We Need More Evidence? Eur Respir Rev. 2019 Feb 27;28(151):180055.

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