Trends in Mortality from Chronic Obstructive Pulmonary Disease Among Adults with Chronic Kidney Disease in the United States: A CDC WONDER Analysis, 1999-2020

Background Chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) frequently coexist, yet mortality trends in patients with both conditions remain poorly characterized. Methods Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates from 1999 to 2020 for adults aged ≥ 25 years with COPD (ICD-10: J40-J44) as the underlying cause and CKD (N18) as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using 2000 US standard population. Trends were assessed via Joinpoint regression, with stratifications by sex, race/ethnicity, age, urbanization, census regions, and state. Results Deaths increased from 1,405 in 1999 to 5,277 in 2020. The AAMR increased from 0.79 in 1999 to 1.96 in 2020. The overall AAPC was + 4.71% (95% CI: 3.06–6.38). Mortality rates were higher in males (AAMR: 2.41) than females (AAMR: 1.65), though females had faster increases (AAPC + 5.86% vs + 3.42%). The 85 + age group had the highest rates (27.98 per 100,000) and fastest growth (APC + 6.43%). NH White individuals exhibited the steepest increase (AAPC + 5.25%), while NH Black individuals had no significant trend (AAPC − 0.22%). Nonmetropolitan areas had higher AAMRs (2.68) compared to metropolitan areas (1.82). Regionally, the Midwest recorded the highest AAPC (+ 5.32%) and 2020 AAMR (2.42). State-level AAPCs ranged from 1.5% to 7.0%. Conclusion Rising COPD-related mortality among adults with CKD highlights a need for integrated pulmonary-renal care, targeted interventions for high-risk populations, and policies addressing rural healthcare access and environmental risk factors.