Trends in mortality from COPD in selected U.S. States differing in tobacco control efforts.

U.S. state tobacco control programs have been associated with both temporal increases in smoking cessation rates in young adults and temporal declines in tobacco-related chronic diseases, but mortality from chronic obstructive pulmonary disease apparently has not been studied. Annual percent change (APC) (1990-2005) in age standardized mortality rate at ages 35-64 and 65+ years from this cause was analyzed for California (which started a comprehensive tobacco control program in 1989), the "U.S. exclusive of California," New Jersey and New York (which had relatively high cigarette prices in the 1990s), and a group of six southern tobacco-growing states (which had limited tobacco control efforts and low cigarette prices in the 1990s). Declines in mortality rates from 1990-2005 for age 35-64 were larger and statistically significant in California (annual % change -1.6%) and New Jersey-New York (annual % change -1.8%), while declines the "U.S. exclusive of California" (annual % change -0.5%) and in six southern tobacco-growing states (annual % change -0.3%). Declines in mortality at age 65+ years were small or nonexistent. The geographic differences in mortality for age 35-64 years after 1990 were not a continuation of earlier trends (in 1980-89), and may be related to differences in tobacco control efforts. This suggests that states should increase their tobacco-control efforts, to reduce chronic obstructive pulmonary disease mortality in the entire U.S.