Study objective: To describe factors associated with COPD deaths in the United States.

Design: Cross-sectional survey.

Participants:A total of 12,803 decedents in the National Mortality Followback Survey, a nationally representative sample of US deaths in 1993.

Methods: We compared the characteristics of adults ≥ 35 years of age who died with COPD (bronchitis, emphysema, chronic airway obstruction) with those dying without COPD listed on their death certificates.

Results: Of the estimated 225,400 adults who died with COPD in 1993, 16.7% had never smoked. People dying with COPD were more likely than those dying without COPD to be current smokers (odds ratio [OR], 6.5; 95% confidence interval [CI], 4.3 to 9.9) or former smokers (OR, 3.7; 95% CI, 2.5 to 5.3), have a history of asthma (OR, 5.0; 95% CI, 3.2 to 7.8), be underweight (OR, 4.5; 95% CI, 2.8 to 7.2), and be of the white race (OR, 3.1; 95% CI, 2.4 to 4.0), after controlling for age group and sex.

Conclusions: A significant proportion of COPD-related deaths occurs in never-smokers. Factors such as a history of asthma and being underweight are associated with COPD mortality and may provide additional opportunities for intervention.