ALARMING INCREASE IN DEATHS FROM CHRONIC LOWER RESPIRATORY DISEASES IN RURAL ALABAMA

While several other rural health issues have been receiving greater attention, deaths due to chronic lower respiratory diseases (CLRD) have been increasing dramatically in Alabama’s rural areas. CLRD includes bronchitis, emphysema, asthma, and other or incompletely specified respiratory diseases. The vast majority (96 percent) of all CLRD deaths in Alabama, as well as the nation and all 50 states, are classified as other or incompletely specified respiratory diseases as specified on death certificates.

Between 2000 and 2016, Alabama’s age-adjusted death or mortality rate from all causes of death has decreased by over 8 percent. During these same years, Alabama’s death rate from CLRD increased by nearly 24 percent, the second highest increase among all 50 states.

In 2000, there were 2,057 deaths to Alabama residents from CLRD for an age-adjusted death rate of 45.4 deaths per 100,000 standardized population. This was the 27th highest rate among all 50 states and was slightly higher than the national rate of 44.2. By 2016, the number of deaths from CLRD increased to 3,326 in Alabama and the rate increased to 56.2. This was the 7th highest rate among all 50 states and was significantly higher than the national rate which had declined to 40.6.

While this dramatic increase of 24 percent statewide is concerning, the highly disproportionate increase in our rural areas and the tremendous increase among rural females demands attention. The death rate from CLRD among Alabama’s rural residents increased from 43.7 in 2000 to 66.4 in 2016, a 50 percent increase. The death rate from CLRD among Alabama’s urban residents increased from 46.8 in 2000 to 49.0 in 2016, a 5 percent increase.

The table below presents CLRD death rates for several demographic components of Alabama’s rural and urban residents. The following observations from this data are of special interest:

In 2000, the CLRD death rate was greater among Alabama’s urban residents. By 2016, this rate was considerably higher among our rural residents.

This rate tends to be significantly higher among white Alabamians than among African Alabamians.

There was an increase of 53 percent between 2000 and 2016 among rural white Alabamians compared to only 6 percent among urban white Alabamians. This same disparity is seen when comparing rural African Alabamians and urban African Alabamians.

The CLRD death rate is significantly higher among males than females. However, the rate for rural females increased by over 94 percent between 2000 and 2016, from 30.4 to 59.1.

The death rates for the elderly (age 65 years or more) were higher for urban residents in 2000. By 2016, these rates reflected dramatic increases among rural residents which were considerably higher than the rates for urban residents.

Rural Alabama Counties Urban Alabama Counties
Deaths Rate Deaths Rate
Year 2000 861 43.7 1,196 46.8
Year 2016 1,642 66.4 1,684 49.0
White Alabamians
2000 783 48.7 1,049 52.2
2016 1,507 74.4 1,456 55.1
African Alabamians
2000 77 22.1 146 27.1
2016 133 31.7 220 28.3
Males
2000 501 65.5 625 65.2
2016 818 77.0 813 57.7
Females
2000 360 30.4 571 36.7
2016 824 59.1 871 43.7
2000 – Age Groups
35-44 years 0 N.A. 13 N.A.
45-54 years 38 15.5 29 8.2
55-64 years 108 58.9 129 55.6
65-74 years 254 184.5 357 199.4
75-84 years 315 375.8 433 386.8
85 or more years 142 466.7 229 621.1
2016 – Age Groups
35-44 years 12 N.A. 0 N.A.
45-54 years 59 23.1 55 14.2
55-64 years 234 91.4 209 53.7
65-74 years 488 247.7 441 164.8
75-84 years 542 538.5 585 441.6
85 or more years 300 877.1 379 721.2

SOURCE: CDC Wonder, Detailed Mortality Database, accessed on April 24, 2018. https://wonder.cdc.gov/

(Dale Quinney, April 26, 2018)

More in-depth research is needed on this disturbing trend to better identify what is causing this increase in CLRD deaths and what intervention(s) are possible to disrupt this trend.