August 2004 
 
volume 20 number 08 
 
Chronic Lower Respiratory Disease Mortality and Morbidity in Georgia, 1999 - 2002 
 
Introduction 
Chronic lower respiratory disease is a common condition characterized by airflow obstruction that is not fully reversible and breathingrelated symptoms such as chronic cough, exertional dyspnea, expectoration, and wheeze.1 Chronic lower respiratory disease includes chronic bronchitis, emphysema, and bronchiectasis. The major cause of chronic lower respiratory disease is smoking; 80% to 90% of all patients with chronic lower respiratory disease have a history of smoking.2, 3 Smoking cessation is the only intervention that has proven successful in reducing the rate of decline in lung function.4 Other factors that may contribute to chronic lower respiratory disease are exposure to dust, fumes, or gases that may be found in the home or workplace.5 
 
on hospital inpatient discharge data for Georgia residents who were hospitalized during 1999 through 2002 at non-federal acute care hospitals with chronic lower respiratory disease as the principle diagnosis. The ICD-9-CM codes used to select hospitalizations were 490-492, 494, and 496. Rates were age adjusted to the 2000 US standard population. Hospital charges are based upon a hospital's full established rates and differ from costs. The amount a hospital is reimbursed is usually less than what is charged. 
Results Mortality Age-adjusted chronic lower respiratory disease death rates increased from 1979 to 1998 (Figure 
 
1). In 1999, the classification system for cause of death coding changed from ICD-9 to ICD10 making recent trends more difficult to interpret, but rates appear to be increasing. The average annual death rate from 1999 through 2002 for chronic lower respiratory disease in Georgia was 46 per 100,000 population. From 1999-2002 there were approximately 11,800 deaths due to chronic lower respiratory disease, an average of 2,950 deaths per year. 
Chronic lower respiratory disease rates have increased in both males and females over time (Figure 2). Death rates for males in Georgia have been consistently higher than the rates 
 
Chronic lower respiratory disease is a major cause of morbidity and mortality in the United States (US). It affects more than 17 million Americans and causes approximately 150 million days of disability per year.6 It is the fourth leading cause of death in the US with more than 100,000 deaths each year.7 Chronic lower respiratory disease results in more than 500,000 hospitalizations per year 8 and costs the nation over 18 billion dollars a year in direct costs.9 
 
Deaths per 100,000 population 
 
Figure 1. Age-adjusted chronic lower respiratory disease death rates, United States & Georgia 1999-2002 
Deaths per 100,000 population 
 
Chronic lower respiratory disease is a large and growing public health problem in Georgia. It is the fifth leading cause of death in Georgia with approximately 2,950 deaths per year and more than 17,650 hospitalizations with chronic lower respiratory disease as the principle diagnosis. This report will discuss the burden of chronic lower respiratory disease in Georgia 
in terms of deaths and hospitalizations. 
 
Figure 2. Age-adjusted chronic lower respiratory disease death rates by sex, Georgia 1979-2002 
 
Deaths per 100,000 population 
 
Methods 
Analyses for this report were conducted using Georgia death certificate data and Georgia hospital inpatient discharge data. For this report, we defined chronic lower respiratory disease as chronic bronchitis, emphysema, bronchiectasis, and chronic lower respiratory disease not otherwise specified. 
 
Deaths from 1979 through 1998 with ICD-9 codes 490-492, 494, and 496 and deaths from 1999 through 2002 with ICD-10 codes J40-J44 and J47 (using CDC's WONDER website and Georgia's vital statistics data) were selected, and age-adjusted death rates over time were obtained. Hospital data in the report are based 
 
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 for females; however, female rates are increasing faster than male rates each year (an increase of 1.3 per 100,000 per year vs. 0.8 per 100,000 per year). The steady increase in female chronic lower respiratory disease death rates mirrors the increase in female smoking rates until the mid 1960's. 10 Many diseases disproportionately affect minorities, but whites were 2.1 times more likely to die from chronic lower respiratory disease than blacks (Figure 3). Chronic lower respiratory disease death rates increased with age (Figure 4). 
Mortality by County Twenty-two of Georgia's 159 counties had death rates in 1999-2002 that were significantly higher than the state rate (46 deaths per 100,000 population) (Figure 5). Counties with high rates are scattered throughout Georgia. 
Morbidity During 2001 there were more than 17,650 hospitalizations (253 per 100,000 population) with chronic lower respiratory disease as the principle diagnosis in Georgia. Hospital charges in Georgia for chronic lower respiratory disease hospitalizations totaled approximately $200 million dollars in 2001. Age-adjusted hospitalization rates were five times higher than death rates. Hospitalization rates in Georgia among males were slightly higher than rates among females (260 per 100,000 vs. 254 per 100,000 population). Whites were 1.6 times more likely to be hospitalized from chronic lower respiratory disease than blacks (271 per 100,000 vs. 169 per 100,000 population). White females had the highest hospitalization rates (282 per 100,000 population) among the four major race/sex groups (Figure 6). Hospitalization rates for chronic lower respiratory diseases were highest among the elderly population. 
Smoking Prevalence Smoking is the most important cause of chronic lower respiratory disease. The prevalence of smoking among adults in Georgia declined about 2.6% per year from 1985 to 1993, but has been increasing slowly, about 0.6% per year, since then. The percentage of adults who smoked in Georgia was consistently higher among males than females from 1985 to 2002 (Figure 7). During the same period, the percentage of adults who smoked was also higher among whites than blacks for both males and females. 
Conclusions Chronic lower respiratory disease is a significant contributor to mortality and morbidity in Georgia, with an average of 2,950 deaths per year from 1999-2002, and approximately 17,650 hospitalizations in 2001. Chronic lower respiratory disease affects all races, sexes, and age groups, but whites are more likely to die or be 
 
Figure 3. Age-adjusted chronic lower respiratory disease deaths rates by race, Georgia, 1999-2002 
Figure 4. Chronic lower respiratory disease death rates by age group, Georgia 1999-2002 
Figure 5. Age-adjusted death rates for chronic lower respiratory disease, Georgia 1999-2002 
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 Figure 6. Age-adjusted chronic lower respiratory disease hospitalization rates by race and sex, Georgia, 2001 
 
hospitalized from chronic lower respiratory disease than blacks. Males are more likely to die or be hospitalized than females. This may be due to the increase in smoking rates among women since the 1940's, relative to men. 11 Also, older age groups are more frequently affected by chronic lower respiratory disease, which is probably due, in part, to long-term smoking habits. 
 
Despite the fact that smoking has been proven to be the major factor in the development of chronic lower respiratory disease and many other diseases, many Georgians continue to smoke. Smoking cessation interventions and policies can influence trends in chronic lower 
respiratory disease. 
 
Figure 7. Prevalence of smoking among adults (18+ years) by race and sex, Georgia, 1985-2002* 
 
Recommendations 
People who do not smoke should not start, and people who do smoke need to seek help to quit to avoid the development of chronic lower respiratory disease. 
 
People with early chronic lower respiratory disease may be more willing to stop smoking than people with no symptoms, and should be urged to do so. 
 
Exposure to tobacco smoke should be eliminated for people with chronic lower respiratory disease. 
 
* 3 year rolling average Source: Behavior Risk Factor Surveillance System 
 
This article was written by Angela Blackwell, M.P.H., Manxia Wu, M.D., M.P.H., Kristen Mertz, M.D., M.P.H., and Kenneth Powell, M.D., M.P.H. 
 
References 
1) Rennard SI. COPD: Overview of definitions, epidemiology and factors influencing its development. Chest 1985; 113(4Suppl): 23S-41S. 2) U.S. Department of Health Human Services. The Health Benefits of Smoking Cessation. A report of the surgeon general. U.S. Government 
Printing Office, Washington, DC. 1990. 3) British Thoracic Society. BTS Guidelines for the management of COPD. Thorax 1997; 52(Suppl5): S1-S28. 4) Anthonisen NR, Connett JE, Murray RP. Smoking and lung function of Lung Health Study participants after 11 years. American Journal of 
Respiratory and Critical Care Medicine 2002; 166: 675-679. 5) Becklake MR. Chronic airflow limitation: its relationship to work industry occupations. Chest 1985; 88:608-617. 6) Adams PF, Hendershot GE, Marano MA. Current estimates from the National Health Interview Survey, 1996. Vital Health Statistics 1999; 10: 1- 
212. 7) Kochanek KD, Smith BL. Deaths: Preliminary Data for 2002. National Vital Statistics Report; Vol. 52 no. 13 Hyattsville, Maryland: National 
Center for Health Statistics. 2004. 8) Owings MF, Lawrence L. Detailed diagnosis and procedures National Hospital Discharge Survey, 1997. Vital Health Statistics 1999; 13:1-157. 9) Sullivan SD, Ramsey SD, Lee TA. The economic burden of chronic obstructive pulmonary disease. Chest 2000; 117(Suppl): 5S-9S. 10) Data compiled by the Centers for Disease Control and Prevention, Office on Smoking and Health, from the Current Population Survey, 1955, 
and the National Health Interview Surveys, 1965-1994. 11) Shopland DR. Tobacco use and its contribution to early cancer mortality with a special emphasis on cigarette smoking. Environmental Health 
Perspective 1995; 103(Suppl8): 131-142. 
 
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State Epidemiologist 
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PAID ATLANTA, GA PERMIT NO. 4528 
 
August 2004 
 
Volume 20 Number 08 
 
Reported Cases of Selected Notifiable Diseases in Georgia Profile* for May 2004 
 
Selected Notifiable Diseases 
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis 
 
Total Reported for May 2004 
2004 53 2437 11 4 64 1046 18 28 50 12 0 2 0 2 0 115 63 2 4 3 18 0 31 
 
Previous 3 Months Total 
 
Ending May 
 
2002 
 
2003 
 
2004 
 
160 
 
145 
 
124 
 
8486 
 
9072 
 
8187 
 
21 
 
24 
 
21 
 
12 
 
4 
 
13 
 
206 
 
170 
 
183 
 
4570 
 
4373 
 
3449 
 
24 
 
21 
 
42 
 
146 
 
131 
 
89 
 
116 
 
148 
 
174 
 
5 
 
9 
 
17 
 
0 
 
5 
 
4 
 
12 
 
9 
 
3 
 
2 
 
1 
 
0 
 
9 
 
12 
 
7 
 
0 
 
0 
 
0 
 
316 
 
254 
 
244 
 
314 
 
374 
 
156 
 
21 
 
31 
 
16 
 
71 
 
123 
 
57 
 
153 
 
230 
 
73 
 
180 
 
232 
 
99 
 
4 
 
3 
 
0 
 
158 
 
132 
 
118 
 
Previous 12 Months Total 
 
Ending in May 
 
2002 
 
2003 2004 
 
645 
 
657 
 
600 
 
33860 
 
35733 
 
34275 
 
156 
 
117 
 
147 
 
56 
 
38 
 
35 
 
903 
 
904 
 
847 
 
18941 
 
18632 
 
16196 
 
104 
 
74 
 
111 
 
833 
 
504 
 
720 
 
441 
 
546 
 
714 
 
14 
 
26 
 
40 
 
2 
 
12 
 
8 
 
42 
 
34 
 
26 
 
4 
 
1 
 
2 
 
26 
 
34 
 
28 
 
0 
 
0 
 
1 
 
1787 
 
1893 
 
2057 
 
1130 
 
1962 
 
822 
 
106 
 
116 
 
123 
 
296 
 
423 
 
401 
 
684 
 
790 
 
525 
 
801 
 
829 
 
654 
 
22 
 
12 
 
5 
 
572 
 
551 
 
535 
 
* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia. 
 
** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis. 
 
AIDS Profile Update 
 
Report Period 
Latest 12 Months: 08/03-07/04 Five Years Ago: 08/99-07/00 Cumulative: 07/81-07/04 
 
Total Cases Reported* <13yrs >=13yrs Total 
 
8 
 
1,844 1,852 
 
8 
 
1,316 1,324 
 
219 
 
28,450 28,669 
 
Percent Female 
28.0 
26.9 
18.7 
 
Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood Unknown 
 
34.0 
 
6.8 
 
1.8 
 
14.9 
 
1.0 
 
41.4 
 
32.6 
 
12.5 
 
3.3 
 
20.8 
 
1.7 
 
29.0 
 
46.5 
 
16.4 
 
5.2 
 
14.3 
 
1.9 
 
15.8 
 
Race Distribution (%) White Black Other 
 
20.9 75.3 
 
3.8 
 
20.3 76.3 
 
3.4 
 
32.6 64.8 
 
2.6 
 
MSM - Men having sex with men 
 
IDU - Injection drug users 
 
HS - Heterosexual 
 
* Case totals are accumulated by date of report to the Epidemiology Section 
 
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