Abstract Rationale Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death in the United States in 2023, imposing substantial health and economic burdens while deteriorating the health-related quality of life for patients, families, and communities. Climate change and natural hazards may exacerbate COPD mortality, yet the impact of climate change skepticism remains unclear. Methods In this cross-sectional study, county-level COPD mortality data (2016-2020) were obtained from CDC WONDER. Climate change skepticism data were sourced from the Yale Program on Climate Change Communication. Negative binomial regression models were used to estimate rate ratios (RRs) for COPD mortality across quartiles of climate change skepticism and were stratified by age, sex, race, urbanization, and comorbidities. Mediation analyses were conducted to assess potential pathways through which climate change skepticism may influence COPD mortality, adjusting for community vulnerability. Results A total of 2746 US counties were included in the analysis of COPD mortality. The age-adjusted mortality rate per 100,000 population for COPD was 37.8 (95% CI: 37.7-37.9). COPD mortality was higher in counties with greater climate change skepticism (highest vs. lowest quartile, RR: 1.65; 95% CI: 1.60-1.70). The effects of climate change skepticism were strongest for mortality attributed to concomitant COPD with lung cancer (2.11; 1.99-2.25) and influenza/pneumonia (4.00; 2.67-5.98). Influenza vaccination and smoking significantly mediated the relationship between climate skepticism and COPD mortality, with approximately 10% and 30% of the effect mediated by reduced vaccination coverage and increased smoking prevalence, respectively, in urban counties, and 5% and 17% in rural counties. Conclusions Higher climate change skepticism is associated with increased COPD mortality. Addressing these interconnected factors and their complex interplay through targeted policies and interventions that improve healthcare access and counter climate skepticism-related health behaviors is crucial for reducing COPD mortality and mitigating health disparities, particularly in high-risk and disadvantaged areas. This abstract is funded by: None
Lee et al. (Fri,) studied this question.