The Burden of Chronic Obstructive Pulmonary Disease in the US: A Systematic Review of Nationally Representative Health Surveys.

BACKGROUND

COPD prevalence estimates from US national surveys vary widely, likely reflecting differences in diagnostic criteria and measurement approaches. This review aimed to systematically characterize variability in COPD prevalence estimates across nationally representative US surveys, with emphasis on differences by diagnostic criteria and across key population subgroups.

METHODS

We searched OVID Medline, OVID Embase and PubMed from inception through October 7th, 2025, for observational studies reporting COPD prevalence in the US general population using nationally representative survey data. Estimates were summarized by diagnostic criteria (spirometry, self-reported) and key subgroups (smoking status, sex and race/ethnicity). Risk of bias (RoB) was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

We included 22 studies from four surveys: The National Health and Nutrition Examination Survey (NHANES); The National Health Interview Survey (NHIS); The Behavioral Risk Factor Surveillance System (BRFSS); and The Population Assessment of Tobacco and Health (PATH). RoB scores ranged between 7 and 8 out of a total of 11 points. Six studies used spirometry and 16 used self-reported diagnosis. Spirometry estimates were consistently higher (12.5-13.8%) than self-reported estimates (3.0-7.2%), with NHIS (1997-2020) showing the highest self-reported estimates. When using spirometry, prevalence was highest in males (17.9%-23.7%), but when using self-reported data, prevalence was highest in females (3.0%-8.5%). Current smokers had the highest prevalence in both spirometry (21.2%-25.7%) and self-report (6.3%-16.7%). Prevalence was highest among Non-Hispanic Whites using spirometry (13.8%-17.5%), but it was highest among "Other" when using self-report (1.9%-11.2%). Among the studies that reported prevalence by COPD severity level, most were classified as mild to moderate obstruction.

CONCLUSION

Consistent assessment methods across surveys are necessary to better understand and address the real burden of COPD across the diverse US population, supporting more effective surveillance while informing public health policy and prevention efforts.