Prevalence of chronic obstructive pulmonary disease: county-level risk factors based on the Social Ecological Model

Aims: Chronic obstructive pulmonary disease (COPD) was the third leading cause of death among Americans in 2014. Multiple factors, ranging from proximal (i.e. biological characteristics and behaviors) to distal (i.e. environmental characteristics and policies), have been shown to predict COPD outcomes. The Social Ecological Model (SEM), which specifies that five levels of influence (i.e. intrapersonal, interpersonal, institutional, community, and public policy factors) are implicated in the development of ill health, has not been used in epidemiological studies of COPD prevalence. A better understanding of the community-level correlates of COPD prevalence may improve community health practice. Methods: Using several sources of county-level secondary data ( n = 646), changes in COPD prevalence from 2012 to 2014 were predicted from the five levels of the SEM using ordinary least squares (OLS) hierarchical linear regression. The geographic distribution of county-level changes in COPD prevalence was analyzed with a choropleth map. Results: County-level COPD prevalence increased by 4.76% between 2012 and 2014 overall; however, the greatest increases were observed among counties within the Appalachian region (i.e. counties in West Virginia). Results showed that the SEM, with five levels of influence, was a statistically significant framework for examining changes in county-level COPD prevalence, F = 10.21, p < .001, R 2 = 0.28. Statistically significant county-level predictors of changes in COPD prevalence included racial composition, ethnic composition, poverty, altitude, air pollution, and smoking policy. Conclusion: COPD prevention may be assisted by the implementation of community-based programs rooted in a multilevel approach.