Key result
COVID-19 pandemic fails to alter the declining trend of smoking prevalence among adults with COPD.
Why the study?
Smoking cessation among COPD patients remains suboptimal, and understanding smoking trends during the COVID-19 pandemic is critical for optimizing cessation interventions and addressing health disparities.
Cross-Sectional
Yes
Smoking prevalence among US adults with COPD continued to decline from 2019 to 2021 despite the COVID-19 pandemic, although profound state-level disparities persist.
Pandemic-era smoking decline in COPD may aid cessation efforts; leaves open durability and outcome effects.
Rationale Cigarette smoking remains the leading modifiable risk factor for chronic obstructive pulmonary disease (COPD), yet smoking cessation among COPD patients remains suboptimal. The COVID-19 pandemic profoundly impacted healthcare delivery and patient behavior. Understanding smoking trends among COPD patients during this period is critical for optimizing smoking cessation interventions and addressing persistent health disparities. Methods We conducted cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) data from CDC Chronic Disease Indicators (2019-2021). Population included adults aged ≥18 years with self-reported COPD diagnosis across all 50 U.S. states, District of Columbia, and territories (n = 53 jurisdictions per year, 159 total observations). Primary outcome was age-adjusted prevalence of current smoking among adults with COPD. We calculated national trends, state-level geographic disparities, and temporal changes during pre-pandemic (2019-2020) and pandemic periods (2020-2021) using paired t-tests. Results National smoking prevalence among COPD patients declined from 40.3% (2019) to 35.7% (2021), representing an 11.4% relative reduction (4.6 percentage points absolute decrease). Profound geographic disparities persisted, with 3.91-fold variation between states (range: 13.2% [Puerto Rico] to 51.6% [Vermont]). Temporal analysis revealed 42 of 50 states (84%) demonstrated decreased smoking prevalence (mean state-level change: -4.4pp), while 8 states (16%) showed increases. Greatest improvements: Wyoming (-22.5pp), Alaska (-18.3pp), South Carolina (-15.5pp), Tennessee (-14.2pp), Missouri (-14.1pp). Notable concerning increases: North Dakota (+12.9pp), New Mexico (+12.8pp), Nebraska (+10.3pp), Rhode Island (+9.5pp). COVID-19 pandemic analysis showed continued decline throughout: pre-pandemic change (2019→2020): -2.74pp; pandemic period (2020→2021): -1.69pp (paired t-test: p = 0.59, not significant), indicating resilience in public health efforts.
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Adatsi et al. (2026) conducted a cross-sectional in Chronic obstructive pulmonary disease (COPD). COVID-19 pandemic period (2020-2021) vs. Pre-pandemic period (2019-2020) was evaluated on Age-adjusted prevalence of current smoking among adults with COPD (11.4% relative reduction, p=0.59). National smoking prevalence among adults with COPD declined from 40.3% in 2019 to 35.7% in 2021, though the rate of decline during the COVID-19 pandemic did not significantly change (p=0.59).
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