The States Facing America’s Biggest Respiratory Gap

Home respiratory supply purchasing varies widely by state. This analysis compares Vitality Medical’s observed purchasing intensity with public respiratory burden indicators.

A new state-by-state analysis from Vitality Medical shows that response is far from uniform. Six of the Top 10 states in the Respiratory Readiness Index are in the South, where the region’s average respiratory burden score reaches 50.3 out of 100. At the same time, three Mountain West states post the highest per-capita home therapy demand in the country.

That contrast defines the story. In some places, high disease burden is matched by strong at-home purchasing. In others, public burden indicators outpace observed Vitality purchasing, suggesting a burden–demand divergence that may reflect channel, coverage, logistics, or awareness differences.

The index combines Vitality Medical’s state-level respiratory therapy sales, adjusted for residents age 65+, with public data on COPD, asthma, and smoking prevalence to create a single Respiratory Readiness score.

• 6 of the Top 10 states are in the South, where the average respiratory burden reaches 50.3/100

• Wyoming, Colorado, and Utah lead the nation in per-capita home therapy demand (each above 174 orders per 100,000 residents age 65+)

• West Virginia posts the highest overall respiratory burden in the index

• Alaska and Hawaii record under 1 order per 100,000 residents age 65+, the lowest measured demand

• The South has the highest regional RRI score at 44.9, while the West leads in demand with 47.7

• The largest burden-demand divergence appears in West Virginia (+64.0) and Alaska (+45.9)

In these states, home respiratory care appears closely tied to health risk levels.

At the other end are states where both burden and buying are relatively lower.

This does not mean respiratory illness is absent. It means the combined burden and purchasing signal is softer in this dataset.

The index measures overlap, not absence.

Chronic respiratory illness does not spread evenly across the country.

The South posts the highest average RRI score at 44.9, driven largely by a regional burden score of 50.3. Higher rates of COPD and cigarette smoking in several Southern states push those numbers upward.

West Virginia sits at the center of that story. The state ranks second overall but leads the nation in respiratory burden, with elevated rates of COPD, adult asthma, and smoking. Its demand score of 36.0 lags well behind its burden score of 100.0, a stark imbalance that highlights a large burden–demand divergence in this dataset.

In practical terms, that gap could translate to delayed adoption of at-home oxygen supplies, nebulizers, or monitoring devices that help patients manage flare-ups outside a hospital setting.

Then there’s the Mountain West, where buying behavior tells a different story.

Wyoming ranks first overall with an RRI score of 70.6, fueled by a demand score of 96.1. The state records 203.2 orders per 100,000 residents age 65+, along with the highest per-capita revenue signal in the dataset.

Colorado and Utah follow closely behind, each exceeding 174 orders per 100,000 residents age 65+. Their burden scores are comparatively lower, yet demand remains strong.

What drives that behavior? It could reflect proactive health management, stronger purchasing channels, or greater familiarity with home respiratory care tools like CPAP supplies and pulse oximeters. Whatever the reason, these states show that high demand does not always require the highest burden.

The most striking pattern appears in states where disease burden far exceeds measured purchasing.

West Virginia posts a +64.0 gap between burden and demand. Alaska follows with +45.9, despite relatively modest measured demand of just 0.9 orders per 100,000 residents age 65+. Tennessee, Kentucky, and Maine round out the Top 5 gap states.

A gap does not automatically signal neglect. It may reflect different buying channels, insurance coverage structures, rural access challenges, or lower awareness of home therapy options.

Still, the pattern raises questions. If public burden indicators are high but observed Vitality purchasing is lower, it may indicate differences in purchasing channels, coverage, logistics, or awareness, not necessarily unmet clinical need.

At the other end of the index are states where both burden and buying remain comparatively low.

Hawaii ranks last overall with an RRI score of 10.5, and Alaska ranks 49th. Several Midwestern and Northeastern states cluster in the lower tier, showing balanced but modest scores on both burden and demand.

Lower ranking does not mean respiratory illness is absent. It means the combined burden and buying signal is softer in this dataset.

Zoom out and the map splits into distinct patterns.

The South carries the heaviest average burden. The West leads in per-capita demand. The Midwest and Northeast sit in the middle, with moderate scores on both sides.

Because demand was normalized to residents age 65+, large states do not win automatically. The ranking shows where older adults are buying or not buying respiratory supplies compared with their peers.

That normalization matters. Respiratory therapies skew older, and comparing raw totals would blur the picture.

Respiratory readiness is about more than diagnosis rates. It shapes how communities absorb seasonal strain and whether patients manage symptoms at home or end up in urgent care.

In high-burden states, proactive home monitoring, infection control, and access to oxygen or airway clearance tools can help patients manage flare-ups before they escalate. In high-demand states, purchasing patterns suggest patients and caregivers are already leaning into home-based care.

The gap states sit somewhere in between. They represent opportunity, not in a commercial sense, but in an educational one. When burden outpaces buying, clearer guidance, improved access to supplies, and stronger awareness around home respiratory care could shift outcomes during peak seasons.

Breathing is one of the few health signals we feel immediately. You notice it the moment it is strained.

This index does not diagnose anyone. It maps where respiratory strain and response meet and where they do not. In a country where chronic respiratory illness touches millions, that intersection is more than a data point. It is a preparedness story.

The Respiratory Readiness Index (RRI) blends two components: respiratory burden and at-home respiratory therapy demand.

Demand is based on Vitality Medical’s state-level respiratory therapy sales, including orders, units, and revenue, normalized per 100,000 residents age 65+ using U.S. Census estimates.

Burden incorporates three public health indicators:

• Adult COPD prevalence (2021)

• Adult current asthma prevalence (2023)

• Adult cigarette smoking prevalence (2022)

Each metric is converted to a 0–100 scale. The RRI score equals the average of the Demand Score and Burden Score. The gap equals Burden Score minus Demand Score.

Vitality sales reflect purchasing through its channels and do not represent all respiratory equipment use statewide. Public health prevalence estimates are survey-based. The RRI is designed for comparative ranking and storytelling, not clinical diagnosis.

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