Socioeconomic status, race and COPD health outcomes

• Published in: Journal of epidemiology and community health (1979) 2011-01, Vol.65 (1), p.26-34
• Main Authors: Eisner, M D, Blanc, P D, Omachi, T A, Yelin, E H, Sidney, S, Katz, P P, Ackerson, L M, Sanchez, G, Tolstykh, Irina, Iribarren, C
• Format: Article
• Language: English
• Subjects: Aged; Asthma; Biological and medical sciences; Body mass index; California - epidemiology; Chronic di; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Cross-Sectional Studies; Disease models; Educational attainment; Female; Follow-Up Studies; General aspects; Health care; Health outcomes; Health risk assessment; Health Services Accessibility; Health Status Disparities; Hospitalization - statistics & numerical data; Household income; Humans; Low income; Male; Medical sciences; Medicare; Middle Aged; Miscellaneous; Pneumology; Proportional Hazards Models; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - ethnology; Pulmonary Disease, Chronic Obstructive - therapy; Racial Groups; Referents; Research reports; respiratory epidem; Respiratory function; Risk Factors; Severity of Illness Index; social inequalities; Socioeconomic Factors; Socioeconomic status; Socioeconomics; Studies; Treatment Outcome; United States
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2009.089722

BackgroundAlthough chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race–ethnicity on health outcomes.MethodsThe aim of this study is to determine the independent impacts of SES and race–ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD.ResultsLower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively).ConclusionLow SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes.