Behavioral Risk Factor Surveillance System (BRFSS)
The Behavioral Risk Factor Surveillance System (BRFSS) provides COPD prevalence data by state.
Like the NHIS, it is a telephone survey of the noninstitutionalized U.S. population aged 18 and over
that collects information about modifiable risk factors for chronic diseases and other leading causes
of death but at the state level. Data from 2011 marks the first year that questions on COPD
prevalence estimates by state are available.
In contrast to the two separate questions about chronic bronchitis and emphysema asked on the
NHIS, the BRFSS uses one question to assess COPD prevalence:
• Have you ever been diagnosed with chronic obstructive pulmonary disease, emphysema or
chronic bronchitis?
Table 5 shows state-specific COPD prevalence estimates and age adjusted rates overall and by sex.
According to the 2011 BRFSS, an estimated 14.7 million adults (6.2%) had been diagnosed with
COPD, compared to 12.7 million (5.5%) from the 2011 NHIS.11 This higher estimate was expected
based on the different question format including multiple potential diagnosis names (COPD as an
acronym and spelled out as well as chronic bronchitis and emphysema) and the universal use of
lifetime diagnosis, instead of past year for chronic bronchitis.
Kentucky had the highest age-adjusted rate at 9.7%, followed by Alabama at 9.4%, while Minnesota
(4.0%) and Washington (4.1%) were among the lowest. Kentucky was also highest for men (8.4%),
while Washington (3.3%) and Washington D.C. (3.5%) were lowest. Among women, Tennessee had
the highest age-adjusted rate (11.5%) and Minnesota the lowest (4.3%). The total age-adjusted
rates are translated into a heat map by state in Figure 8, which shows that rates tend to be higher
in the Midwest and Southeast.12