Socioeconomic status, race and COPD health outcomes.
BACKGROUND
Although 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.


METHODS
The 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.


RESULTS
Lower 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).


CONCLUSIONS
Low 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.
Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA. mark.eisner@ucsf.edu
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Eisner
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Yelin
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Ackerson
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Sanchez
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D000368:Aged; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D044469:Racial Groups; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States