Morbidity and Mortality Weekly Report Weekly / Vol. 64 / No. 11 March 27, 2015 Employment and Activity Limitations Among Adults with Chronic Obstructive Pulmonary Disease — United States, 2013 Anne G. Wheaton, PhD1, Timothy J. Cunningham, PhD1, Earl S. Ford, MD1, Janet B. Croft, PhD1 (Author affiliations at end of text) Chronic obstructive pulmonary disease (COPD) is a group a random-digit–dialed telephone survey (landline and cell of progressive respiratory conditions, including emphysema phone) of noninstitutionalized civilian adults aged ≥18 years and chronic bronchitis, characterized by airflow obstruction that includes various questions about respondents’ health and and symptoms such as shortness of breath, chronic cough, risk behaviors. Response rates for BRFSS are calculated using and sputum production. COPD is an important contributor standards set by the American Association of Public Opinion to mortality and disability in the United States (1,2). Healthy Research Response Rate Formula #4.† The response rate is the People 2020 has several COPD-related objectives,* including number of respondents who completed the survey as a pro- to reduce activity limitations among adults with COPD. To portion of all eligible and likely eligible persons. The median assess the state-level prevalence of COPD and the associa- survey response rate for all states, territories, and DC in 2013 tion of COPD with various activity limitations among U.S. was 46.4%, and ranged from 29.0% to 60.3%. Additional adults, CDC analyzed data from the 2013 Behavioral Risk information is presented in the BRFSS 2013 Summary Data Factor Surveillance System (BRFSS). Among U.S. adults in Quality Report.§ all 50 states, the District of Columbia (DC), and two U.S. territories, 6.4% (an estimated 15.7 million adults) had been † Available at http://www.aapor.org/AAPORKentico/AAPOR_Main/media/ MainSiteFiles/StandardDefinitions2011_1.pdf. told by a physician or other health professional that they have § Available at http://www.cdc.gov/brfss/annual_data/2013/pdf/2013_DQR.pdf. COPD. Adults who reported having COPD were more likely to report being unable to work (24.3% versus 5.3%), having an activity limitation caused by health problems (49.6% versus INSIDE 16.9%), having difficulty walking or climbing stairs (38.4% 296 Mycoplasma pneumoniae Outbreak in a Long-Term versus 11.3%), or using special equipment to manage health Care Facility — Nebraska, 2014 problems (22.1% versus 6.7%), compared with adults without 300 Use of 9-Valent Human Papillomavirus (HPV) COPD. Smokers who have been diagnosed with COPD are Vaccine: Updated HPV Vaccination encouraged to quit smoking, which can slow the progression Recommendations of the Advisory Committee on of the disease (3) and reduce mobility impairment (4). In Immunization Practices addition, COPD patients should consider participation in 305 Updated Recommendations for the Use of Typhoid a pulmonary rehabilitation program that combines patient Vaccine — Advisory Committee on Immunization education and exercise training to address barriers to physical Practices, United States, 2015 activity, such as respiratory symptoms and muscle wasting (5). 309 Announcement Each year, the BRFSS survey is administered by state 310 QuickStats health departments in collaboration with CDC. BRFSS is * Additional information available at http://www.healthypeople.gov/2020/topics- Continuing Education examination available at objectives/topic/respiratory-diseases/objectives?topicId=36. http://www.cdc.gov/mmwr/cme/conted_info.html#weekly. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Self-reported, physician-diagnosed COPD was defined as a physical activity status, and activity limitation characteristics. positive response to the question, “Have you ever been told by Additionally, the age-adjusted prevalence of activity limitation a doctor or health professional that you have COPD, emphy- measures was calculated by COPD status, current smoking sema, or chronic bronchitis?” Several questions addressed activ- status, and physical activity status. T-tests were used to com- ity limitations: “Are you limited in any way in any activities pare prevalence between subgroups (significance at p<0.05). because of physical, mental, or emotional problems?”; “Do All indicated differences between subgroups are statistically you have serious difficulty walking or climbing stairs?”; and significant. Data are weighted to state population estimates, “Do you now have any health problem that requires you to use and statistical software that took into account the complex special equipment, such as a cane, a wheelchair, a special bed, sampling design was used. or a special telephone?” Being unable to work was defined for Overall, 6.4% of U.S. adults (an estimated 15.7 million) were respondents who reported they were unable to work in response told by a physician or other health care provider that they have to the question, “Are you currently…? Employed for wages, COPD (age-adjusted prevalence = 6.0%) (Table). Prevalence self-employed, out of work for 1 year or more, out of work for of COPD ranged from 2.6% among those aged 18–34 years less than 1 year, a homemaker, a student, retired, or unable to to 12.3% among those aged ≥75 years. In age-adjusted com- work.” Current smokers reported having smoked at least 100 parisons by race/ethnicity, Asians were the least likely to report cigarettes in their life and currently smoking cigarettes some COPD (2.0%), whereas adults who identified themselves as days or every day. Former smokers reported having smoked at multiracial or American Indian/Alaska Native reported the least 100 cigarettes in their life but were not current smokers. highest prevalence (10.7% and 10.2%, respectively). Women Respondents were categorized as engaging in physical activity if were more likely to report COPD than men (6.6% compared they answered “yes” to the question, “During the past month, with 5.4%). COPD prevalence was lower among employed other than your regular job, did you participate in any physi- adults (3.6%) compared with other employment categories. cal activities or exercises such as running, calisthenics, golf, COPD prevalence was lower with greater educational level. gardening, or walking for exercise?” COPD also varied by marital status, with divorced, widowed, The age-adjusted prevalence of self-reported, physician-diag- or separated respondents being more likely to report COPD nosed COPD (with 95% confidence intervals) was calculated (9.1%) than married respondents (4.7%). COPD was more by state, selected demographic characteristics, smoking status, common among current smokers (14.3%) than former smokers The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2015;64:[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science Joanne Cono, MD, ScM, Director, Office of Science Quality Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Weekly) Sonja A. Rasmussen, MD, MS, Editor-in-Chief Martha F. Boyd, Lead Visual Information Specialist Charlotte K. Kent, PhD, MPH, Executive Editor Maureen A. Leahy, Julia C. Martinroe, John S. Moran, MD, MPH, Editor Stephen R. Spriggs Teresa F. Rutledge, Managing Editor Visual Information Specialists Douglas W. Weatherwax, Lead Technical Writer-Editor Quang M. Doan, MBA, Phyllis H. King, Terraye M. Starr Jude C. Rutledge, Writer-Editor Information Technology Specialists MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman King K. Holmes, MD, PhD, Seattle, WA Matthew L. Boulton, MD, MPH, Ann Arbor, MI Timothy F. Jones, MD, Nashville, TN Virginia A. Caine, MD, Indianapolis, IN Rima F. Khabbaz, MD, Atlanta, GA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patricia Quinlisk, MD, MPH, Des Moines, IA David W. Fleming, MD, Seattle, WA Patrick L. Remington, MD, MPH, Madison, WI William E. Halperin, MD, DrPH, MPH, Newark, NJ William Schaffner, MD, Nashville, TN 290 MMWR / March 27, 2015 / Vol. 64 / No. 11 Morbidity and Mortality Weekly Report TABLE. Age-adjusted* percentage of adults aged ≥18 years reporting having ever been told by a physician that they had chronic obstructive pulmonary disease (COPD)†, by selected characteristics — Behavioral Risk Factor Surveillance System, United States, 2013 Characteristic No. %§ (95% CI) Estimated no.¶ with COPD Total respondents (crude) 486,921 6.4 (6.3–6.5) 15,667,000 Total (age-adjusted) 486,921 6.0 (5.9–6.1) Age group (yrs) (unadjusted) 18–34 77,294 2.6 (2.4–2.8) 1,931,000 35–44 59,556 3.6 (3.3–3.9) 1,447,000 45–54 83,324 6.7 (6.4–7.1) 2,976,000 55–64 106,090 9.7 (9.3–10.0) 3,823,000 65–74 89,992 11.8 (11.4–12.2) 3,061,000 ≥75 70,665 12.3 (11.8–12.8) 2,429,000 Race/Ethnicity White, non-Hispanic 373,527 6.3 (6.2–6.5) 11,237,000 Black, non-Hispanic 38,686 6.5 (6.1–6.9) 1,844,000 American Indian/Alaska Native, non-Hispanic 7,626 10.2 (8.8–11.7) 267,000 Asian, non-Hispanic 9,381 2.0 (1.4–2.9) 181,000