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Age-adjusted mortality rates (AAMRs) per 100,000 population 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 average annual percent change (AAPC) was +\u20094.71% (95% CI: 3.06\u20136.38). Mortality rates were higher in males (AAMR: 2.41) than females (AAMR: 1.65), though females had faster increases (AAPC\u2009+\u20095.86% vs.\u2009+\u20093.42%). The 85\u2009+\u2009age group had the highest rates (27.98 per 100,000 population) and fastest growth (APC\u2009+\u20096.43%). non-Hispanic (NH) White individuals exhibited the steepest increase (AAPC\u2009+\u20095.25%), while NH Black individuals had no significant trend (AAPC\u2009\u2212\u20090.22%). Nonmetropolitan areas had higher AAMRs (2.68) compared to metropolitan areas (1.82). Regionally, the Midwest recorded the highest AAPC (+\u20095.32%) and 2020 AAMR (2.42). State-level AAPCs ranged from 1.5% to 7.0%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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. These estimates reflect deaths certified with COPD as the underlying cause and CKD as a contributing cause, and therefore do not represent mortality among all individuals with coexisting COPD and CKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-026-04499-2","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T03:45:13Z","timestamp":1783914313000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in mortality with chronic obstructive pulmonary disease as the underlying cause and chronic kidney disease as a contributing cause among US adults, 1999\u20132020: a CDC WONDER analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Chengying","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoxin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"5","key":"4499_CR1","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/S2213-2600(21)00511-7","volume":"10","author":"D Adeloye","year":"2022","unstructured":"Adeloye D, Song P, Zhu Y, et al. 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