title: Chronic obstructive pulmonary disease and socioeconomic status: a systematic review.
abstract: BACKGROUND
  Along with age and sex, socioeconomic status is one of the most powerful determinants of health. We conducted a systematic review to examine the consistency and magnitude of the association between socioeconomic status and COPD health outcomes to determine the potential impact of SES disparity on the COPD population.
  
  
  METHODS
  Electronic databases to October 2011 were searched for studies of adults who had or were at risk for COPD that quantified an association between a measure of socioeconomic status and at least one COPD health outcome. Two authors independently reviewed studies, assessed study quality, and for eligible studies, extracted data.
  
  
  RESULTS
  Regardless of the population, socioeconomic status measure or COPD outcome examined, with few exceptions, consistent significant inverse associations between socioeconomic status and COPD outcomes were found. Most studies found that individuals of the lowest socioeconomic strata were at least twice as likely to have poor outcomes as those of the highest (range from no difference to 10-fold difference).
  
  
  CONCLUSIONS
  Social and economic disadvantage appears to have a significant consistent impact on COPD mortality and morbidity. These findings point to the need for public health strategies and research to address socioeconomic status disparity in individuals with COPD.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. andrea.gershon@ices.on.ca
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Gershon
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Dolmage
authors.forename: Anne
authors.initials: A
authors.lastname: Stephenson
authors.forename: Beth
authors.initials: B
authors.lastname: Jackson
mesh_terms: D000328:Adult; D054624:Health Status Disparities; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012306:Risk; D012923:Social Class