Trajectories of chronic obstructive pulmonary disease mortality in the United States: joinpoint trend analysis for 1999–2024 and Bayesian age-period-cohort projections for 2025–2035

Chronic obstructive pulmonary disease (COPD) remains a leading cause of death in the United States, yet comprehensive projections of its mortality burden across population subgroups are lacking. This study aimed to assess temporal trends in COPD mortality from 1999 to 2024 and to project future rates through 2035 by demographic and geographic strata. Data on COPD deaths (ICD-10 codes J40-J44) were obtained from the CDC WONDER database. Joinpoint regression was used to estimate annual percent changes (APC) and average annual percent changes (AAPC) in age-adjusted mortality rates (AAMR). Bayesian age-period-cohort (BAPC) models with integrated nested Laplace approximations (INLA) and Joinpoint log-linear extrapolation were employed to project AAMR or crude mortality rates for 2025–2035. Sensitivity analyses tested the robustness of projections to prior specifications and data periods. From 1999 to 2024, a total of 3,520,225 COPD deaths were recorded. Overall AAMR declined from 67.1 (95% CI: 66.7 to 67.4) to 48.2 (95% CI: 47.9 to 48.4) per 100,000, with an acceleration in decline after 2017 (APC = − 3.45, 95% CI: − 4.09 to − 2.81). Most subgroups exhibited similar patterns. However, mortality increased in noncore/nonmetro areas (AAPC = 1.38, 95% CI: 0.84 to 1.93), and rates rose in several Southern states, including Arkansas, Oklahoma, and Mississippi. BAPC projections indicated that the overall AAMR could rise to 76.78 (95% CI: 2.75 to 409.54) by 2035, with the highest point estimate in the Midwest (projected AAMR = 159.45, 95% CI: 2.39 to 953.78). Female AAMR is projected to surpass male AAMR between 2030 and 2035. Mortality in noncore/nonmetro areas and several Southern states (Arkansas, Oklahoma, Mississippi) is expected to continue increasing, whereas all racial/ethnic subgroups and age groups are projected to experience continued declines. COPD mortality trends and future burdens vary substantially across demographic and geographic subgroups. The projected rise in overall AAMR, the potential crossover of female mortality surpassing male mortality, and widening urbanization disparities highlight the need for targeted public health interventions, particularly for middle-aged and older women, rural residents, and populations in the Midwest and South.