Chronic Obstructive Pulmonary Disease and Asthma–Patient Characteristics and Health Impairment

Figures & data

Table 1.  Questions related to obstructive airways disease: Behavioral Risk Factor Surveillance System (BRFSS): North Carolina, 2007 and 2009

Measure	Question
COPD prevalence	“Have you ever been told by a doctor or health professional that you have chronic obstructive pulmonary disease (COPD), emphysema or chronic bronchitis?” *
Asthma prevalence (Ever)	“Have you ever been told by a doctor, nurse, or health professional that you had asthma?”
Asthma prevalence (Current)	“Do you still have asthma?”
Current Smoker	“Have you smoked at least 100 cigarettes in your entire life?”
	“Do you now smoke cigarettes every day, some days, or not at all?”
Health Impairment	“Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”
	Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?”
	“Do you now have any health problem that requires you to use special medical equipment, such as a cane, wheelchair, special bed, or a special telephone?”
	Are you limited in any way in any activities because of physical, mental, or emotional problems?
	“Does shortness of breath affect your quality of life?” *
Breathing Test	“Have you ever received a breathing test to diagnose your COPD, chronic bronchitis, or emphysema?”(2007) *
	“Have you ever been given a breathing test, which measures how much air you can breathe out through a tube, to diagnose your COPD, chronic bronchitis, or emphysema?” (2009) *
Co-morbid Chronic
Conditions	“Have you ever been told by a doctor that you have diabetes?” (Definition for this paper does not include responses regarding diabetes during pregnancy only, pre-diabetes, or borderline diabetes.)
	“Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?” (Definition for this paper does not include responses regarding high blood pressure during pregnancy only, borderline high blood pressure, or pre-hypertension)
	“Has a doctor, nurse, or other health professional ever told you that you had any of the following: a heart attack, also called a myocardial infarction; angina or coronary heart disease?”
	“Has a doctor, nurse, or other health professional ever told you that you had a stroke?”
	“Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”

*BRFSS questions developed specifically to help define COPD.

Table 2.  Distribution of selected characteristics of the adult study population, aged ≥18 years: North Carolina, 2007 and 2009

Characteristic	N	%	95% CI
Total	24,073	100	—
2007	12,844	49.8	(48.8–50.9)
2009	11,229	50.2	(49.1–51.2)
Women	14,954	50.5	(49.5–51.6)
Age, years
18–44	6,872	49.4	(48.4–50.5)
45–54	4,827	19.0	(18.3–19.7)
55–64	5,165	15.1	(14.6–15.7)
65–74	4,191	9.4	(9.0–9.8)
≥75	3,018	7.0	(6.7–7.4)
Race
White	19,376	73.1	(72.0–74.1)
Black	3,319	18.0	(17.1–18.8)
Other	1,378	9.0	(8.2–9.8)
Hispanic ethnicity	782	6.5	(5.7–7.2)
Education, years
<12	2,983	12.6	(11.8–13.4)
12 or high school equivalency	7,086	28.8	(27.8–29.7)
1–3 college	6,282	26.6	(25.7–27.6)
≥4 college	7,722	32.0	(31.1–32.9)
Health care coverage	21,165	82.7	(81.7–83.6)
Last routine doctor visit
<12 months	18,147	71.1	(70.1–72.2)
12–23 months	2,637	12.7	(12.0–13.4)
24–59 months	1,480	7.7	(7.1–8.2)
≥60 months	1,370	7.2	(6.6–7.8)
Never	171	1.3	(0.9–1.7)
Frequent mental distress ≥14 days in past 30 days	2,710	11.4	(10.7–12.1)
Frequent physical distress ≥14 days in past 30 days	3,412	11.5	(10.9–12.2)
Disability	5,975	19.7	(18.9–20.5)
Requires special equipment	2,561	7.3	(6.9–7.7)
Smoking status
Current	4,652	21.8	(20.9–22.7)
Former	7,362	25.8	(25.0–26.7)
Never	11,989	52.4	(51.3–53.5)
Body Mass Index (kg/m^2)
Underweight ( <18.5)	406	1.8	(1.5–2.1)
Normal weight (18.5–24.9)	7,918	33.0	(32.0–34.0)
Overweight (25.0–29.9)	8,728	35.3	(34.3–36.3)
Obese (≥30.0)	7,021	29.9	(28.9–30.9)
Diabetes	2,905	9.1	(8.6–9.6)
Coronary heart disease	2,290	6.9	(6.4–7.5)
Stroke	1,007	2.7	(2.5–3.0)
Arthritis	9,219	28.1	(27.3–29.0)
High blood pressure	9,380	30.2	(29.3–31.1)
Any asthma history	2,908	12.1	(11.4–12.8)
Any current asthma	1,924	7.6	(7.1–8.2)
Any COPD	1,948	5.6	(5.2–6.1)
Obstructive Airway Disease
None	20,024	84.7	(83.9–85.4)
Former asthma history only	853	4.1	(3.7–4.6)
Current asthma only	1,248	5.6	(5.1–6.1)
COPD only	1,141	3.2	(2.9–3.5)
COPD-asthma overlap syndrome	807	2.4	(2.1–2.7)

Figure 1.  Prevalence (%) of selected obstructive airway disease categories among adults aged ≥18 years, by age groups: North Carolina, 2007 and 2009.

Table 3.  Age-adjusted prevalence of obstructive airway disease categories among adults aged ≥18 years, by selected characteristics: North Carolina, 2007 and 2009

Characteristic	Former asthma history only(N = 853)% (95% CI)	Current asthma only(N = 1,248)% (95% CI)	COPD only(N = 1,141)% (95% CI)	COPD-asthma overlap syndrome (N = 807)% (95% CI)
Total	4.2 (3.7–4.7)	5.7 (5.1–6.2)	3.1 (2.7–3.4)	2.3 (2.0–2.6)
2007	3.7 (3.1–4.3)	5.7 (5.0–6.4)	3.3 (2.9–3.7)	2.4 (2.0–2.8)
2009*	4.8 (4.0–5.5)	5.7 (4.9–6.4)	2.8 (2.4–3.3)	2.3 (1.8–2.7)
Sex
Men	4.8 (4.0–5.6)	4.6 (3.8–5.4)	3.3 (2.7–3.9)	1.9 (1.4–2.4)
Women *	3.7 (3.2–4.2)	6.8 (6.1–7.5)	2.8 (2.5–3.1)	2.8 (2.4–3.1)
Race
White *	4.2 (3.6–4.8)	5.7 (5.0–6.3)	2.9 (2.6–3.2)	2.5 (2.1–2.8)
Black	5.2 (4.0–6.3)	7.9 (6.4–9.4)	3.0 (2.0–4.1)	1.5 (1.1–2.0)
Other	3.3 (1.9–4.8)	2.7 (1.6–3.7)	3.1 (2.0–4.3)	3.0 (1.7–4.3)
Hispanic
Yes *	3.5 (1.8–5.1)	1.8 (1.0–2.7)	3.2 (1.7–4.7)	–**
No	4.4 (3.9–4.9)	6.0 (5.5–6.6)	3.0 (2.7–3.3)	2.4 (2.1–2.7)
Education, years
<12	4.2 (2.4–6.1)	6.0 (4.5–7.5)	4.4 (3.6–5.2)	6.5 (4.8–8.1)
12 or high school equivalent	4.2 (3.3–5.1)	6.8 (5.6–8.0)	3.9 (3.2–4.7)	2.3 (1.8–2.7)
1–3 college	4.5 (3.5–5.4)	5.3 (4.3–6.2)	3.4 (2.7–4.0)	2.4 (1.8–2.9)
≥4 college*	4.1 (3.4–4.7)	4.8 (4.1–5.5)	1.6 (1.3–1.9)	0.9 (0.7–1.2)
Health care coverage
Yes *	4.2 (3.1–5.4)	6.0 (4.6–7.4)	3.2 (2.2–4.1)	2.5 (1.8–3.2)
No	4.1 (3.7–4.6)	5.7 (5.2–6.2)	3.1 (2.7–3.4)	2.3 (2.0–2.6)
Last routine doctor visit
<12 months*	3.8 (3.2–4.3)	6.0 (5.3–6.6)	3.0 (2.6–3.4)	2.1 (1.7–2.5)
12–23 months	4.7 (3.6–5.8)	4.5 (3.3–5.7)	2.8 (2.1–3.6)	2.6 (1.8–3.3)
24–59 months	5.8 (4.2–7.5)	5.9 (4.1–7.7)	3.2 (1.8–4.6)	1.9 (1.1–2.7)
≥60 months	4.6 (2.4–6.9)	5.6 (3.5–7.8)	3.0 (1.9–4.2)	3.2 (1.8–4.6)
Never	–**	–**	–**	–**
Obesity (BMI ≥30.0 kg/m^2)
Yes	5.4 (4.2–6.5)	6.7 (5.8–7.7)	3.7 (3.0–4.5)	3.4 (2.7–4.2)
No *	3.7 (3.3–4.2)	5.2 (4.6–5.8)	2.9 (2.5–3.2)	1.9 (1.6–2.1)
Coronary heart disease
Yes	3.9 (1.6–6.3)	6.1 (2.7–9.5)	9.0 (4.8–13.2)	6.8 (4.4–9.3)
No *	4.2 (3.7–4.7)	5.6 (5.1–6.2)	2.6 (2.3–2.9)	2.0 (1.7–2.2)
Stroke
Yes	10.9 (2.0–19.7)	9.5 (3.4–15.7)	7.5 (3.1–11.9)	13.9 (6.1–21.8)
No *	4.2 (3.7–4.7)	5.6 (5.1–6.2)	3.0 (2.7–3.3)	2.2 (1.9–2.5)
Diabetes
Yes	5.7 (3.1–8.2)	8.8 (5.6–12.1)	5.0 (2.9–7.1)	7.1 (3.5–10.6)
No *	4.1 (3.6–4.6)	5.5 (5.0–6.0)	2.9 (2.6–3.3)	2.0 (1.7–2.3)
Arthritis
Yes	4.6 (3.3–5.8)	9.1 (7.4–10.8)	4.8 (3.9–5.7)	4.4 (3.5–5.2)
No *	4.1 (3.6–4.6)	4.8 (4.3–5.4)	2.4 (2.0-2.8)	1.4 (1.1–1.7)
High blood pressure
Yes	5.1 (3.6–6.6)	6.5 (5.3–7.7)	4.2 (3.4–5.0)	3.7 (2.6–4.7)
No *	4.1 (3.5–4.6)	5.3 (4.7–5.9)	2.6 (2.2–2.9)	1.8 (1.5–2.2)
Smoking status
Current	4.9 (3.6–6.1)	5.6 (4.4–6.8)	6.7 (5.7–7.7)	4.4 (3.7–5.2)
Former	4.7 (3.3–6.0)	5.6 (4.3–6.9)	2.8 (2.4–3.3)	2.3 (1.8–2.8)
Never *	3.8 (3.3–4.3)	5.7 (5.1–6.4)	1.4 (1.1–1.7)	1.3 (1.0–1.7)

*Referent group for comparison of the age-adjusted prevalence of a given obstructive airway disease category within each selected characteristics. A percentage is bold if there is a significant difference from that of the referent group (p < 0.05).

**Unreliable estimate because relative standard error ≥30%.

Figure 2.  Age-adjusted percent (%) of adults aged ≥18 years reporting frequent mental distress, frequent physical distress, disability, and/or limitations requiring special equipment, by selected obstructive airway disease categories, North Carolina, 2007 and 2009.

Table 4.  Age-adjusted prevalence and adjusted prevalence ratio of selected health impairments and co-morbid conditions among adults aged ≥18 years, by obstructive airway disease categories: North Carolina, 2007 and 2009

Obstructive Airway Disease	% (95%CI)*	PR (95% CI)**
Frequent mental distress (≥14 in past 30 days)
None	9.7 (9.0–10.4)	1.0 (referent)
Former asthma only	14.8 (10.6–19.0)	1.43 (1.01–2.03)
Current asthma only	18.5 (14.7–22.2)	1.73 (1.34–2.22)
COPD only	24.2 (18.8–29.6)	1.75 (1.35–2.28)
COPD-asthma overlap syndrome	33.2 (27.5–38.8)	2.14 (1.74–2.62)
Frequent physical distress (≥14 in past 30 days)
None	9.2 (8.6–9.9)	1.0 (referent)
Former asthma only	13.5 (9.5–17.4)	1.24 (0.86–1.79)
Current asthma only	21.0 (17.3–24.7)	1.90 (1.51–2.39)
COPD only	29.2 (24.4–33.9)	2.47 (2.06–2.96)
COPD-asthma overlap syndrome	38.4 (33.2–43.6)	2.74 (2.32–3.25)
Disability
None	16.6 (15.8–17.4)	1.0 (referent)
Former asthma only	23.3 (18.8–27.8)	1.27 (0.99–1.63)
Current asthma only	33.4 (29.2–37.6)	1.80 (1.52–2.13)
COPD only	42.2 (37.4–46.9)	2.14 (1.88–2.42)
COPD-asthma overlap syndrome	57.2 (51.1–63.3)	2.57 (2.24–2.94)
Requires special equipment
None	5.9 (5.5–6.3)	1.0 (referent)
Former asthma only	10.9 (6.9–14.8)	1.87 (1.23–2.83)
Current asthma only	11.7 (9.4–13.9)	1.73 (1.34–2.22)
COPD only	15.4 (12.5–18.2)	2.09 (1.64–2.67)
COPD-asthma overlap syndrome	24.7 (20.9–28.5)	3.22 (2.67–3.88)
Diabetes
None	8.3 (7.8–8.9)	1.0 (referent)
Former asthma only	11.4 (8.6–14.2)	1.27 (0.95–1.70)
Current asthma only	12.2 (9.8–14.7)	1.33 (1.04–1.69)
COPD only	11.4 (9.2–13.6)	1.19 (0.94–1.51)
COPD-asthma overlap syndrome	19.1 (14.7–23.5)	1.88 (1.47–2.41)
Coronary heart disease
None	5.9 (5.4–6.5)	1.0 (referent)
Former asthma only	6.8 (4.9–8.7)	1.15 (0.80–1.66)
Current asthma only	7.5 (5.6–9.4)	1.39 (1.04–1.86)
COPD only	16.6 (12.6–20.5)	2.34 (1.81–3.04)
COPD-asthma overlap syndrome	18.8 (15.4–22.2)	2.65 (2.15–3.28)
Stroke
None	2.4 (2.1–2.6)	1.0 (referent)
Former asthma only	3.7 (2.0–5.4)	1.14 (0.69–1.89)
Current asthma only	3.6 (2.4–4.7)	1.26 (0.83–1.90)
COPD only	4.4 (3.3–5.5)	1.57 (1.16–2.13)
COPD-asthma overlap syndrome	7.7 (5.6–9.7)	2.22 (1.63–3.01)
Arthritis
None	26.1 (25.3–27.0)	1.0 (referent)
Former asthma only	30.4 (26.2–34.6)	1.06 (0.89–1.26)
Current asthma only	39.7 (35.9–43.6)	1.38 (1.21–1.56)
COPD only	39.4 (35.0–43.8)	1.31 (1.14–1.50)
COPD-asthma overlap syndrome	50.6 (45.4–55.8)	1.58 (1.41–1.77)
High blood pressure
None	29.1 (28.1–30.0)	1.0 (referent)
Former asthma only	33.8 (29.0–38.6)	1.06 (0.89–1.27)
Current asthma only	34.6 (31.3–38.0)	1.09 (0.97–1.23)
COPD only	38.4 (34.1–42.7)	1.21 (1.08–1.35)
COPD-asthma overlap syndrome	42.1 (36.7–47.5)	1.25 (1.09–1.45)

*Age-adjusted prevalence (%) and 95% confidence interval (CI) for each outcome was obtained by the direct age-standardization method which used the 2000 US standard population.

**Adjusted prevalence ratio (PR) and 95% CI for the likelihood of each outcome associated with a given obstructive airway disease category was obtained from separate multivariable logistic regression models that included age, sex, race/ethnicity, education, health care coverage, routine checkup with physician, obesity, and smoking status as covariates. The referent for all comparisons was the group of respondents with no obstructive airway impairment.

Figure 3.  Age-adjusted percent (%) of adults aged ≥18 years reporting co-morbidities, by selected obstructive airway disease categories, North Carolina, 2007 and 2009.