Climate skepticism, natural hazards, and community vulnerability in COPD mortality among US counties.

[BACKGROUND] Climate change and natural hazards may exacerbate COPD mortality, yet the impact of climate change skepticism and community vulnerability remains unclear.

[METHODS] This cross-sectional study analyzed county-level COPD mortality data (2016–2020) from CDC WONDER. Climate change skepticism data were sourced from the Yale Program on Climate Change Communication. Community hazard risk and vulnerability were assessed using the National Risk Index, Social Vulnerability, Community Resilience, and Social Deprivation Index. Negative binomial regression models estimated rate ratios (RRs) for COPD mortality across quartiles of climate change skepticism and community indices. Mediation analyses assessed potential pathways through which climate change skepticism may influence COPD mortality, adjusting for community vulnerability.

[RESULTS] COPD mortality was higher in counties with greater climate change skepticism (highest vs. lowest quartile, RR: 1.65; 95%CI: 1.60–1.70), higher social vulnerability (1.27; 1.23–1.32), and greater social deprivation (1.42; 1.37–1.47). In contrast, counties with greater natural hazard risk (0.80; 0.77–0.83) and higher community resilience (0.71; 0.68–0.73) had lower mortality. The effects of climate skepticism were strongest for mortality attributed to concomitant COPD with lung cancer (2.11; 1.99–2.25) and influenza/pneumonia (4.00; 2.67–5.98). Influenza vaccination and smoking significantly mediated the relationship between climate skepticism and COPD mortality, with approximately 10% and 30% of the effect mediated by reduced vaccination coverage and increased smoking prevalence, respectively, in urban counties, and 5% and 17% in rural counties.

[CONCLUSIONS] Climate change skepticism, higher social deprivation, and lower community resilience are associated with increased COPD mortality. Climate skepticism may serve as a marker of broader patterns of suboptimal health behaviors and lower engagement with preventive care, which likely contribute more directly to COPD outcomes. Addressing these interconnected factors through targeted policies and interventions to improve healthcare access, counter climate skepticism-related health behaviors, and strengthen community resilience is crucial for reducing COPD mortality and mitigating health disparities, particularly in high-risk and disadvantaged areas.

[SUPPLEMENTARY INFORMATION] The online version contains supplementary material available at 10.1186/s12890-025-04058-1.