Obstructive lung disease in Mexican Americans and non-Hispanic whites: an analysis of diagnosis and survival in the National Health and Nutritional Examination Survey III Follow-up Study.
BACKGROUND
Although obstructive lung disease (OLD), which includes COPD, affects all the populations, Hispanics seem to be protected against COPD development and progression. Whether this advantage translates into a survival benefit for this population is unknown. We aimed to determine the risk for OLD in Mexican Americans, the largest US Hispanic subgroup, compared with non-Hispanic whites and to assess all-cause mortality in subjects with OLD.


METHODS
We assessed the relationships between Mexican American ethnicity and spirometric OLD and risk of death among 6,456 US adults aged ≥ 40 years who participated in the Third National Health and Nutritional Examination Survey Follow-up Study. We used logistic and Cox regression analyses to estimate the OR for OLD among Mexican Americans and the hazard ratio (HR) for all-cause mortality among Mexican Americans with OLD, respectively.


RESULTS
After adjustment for demographic factors, socioeconomic status, and COPD risk factors, Mexican Americans had decreased odds of OLD diagnosis compared with whites (OR, 0.72 [95% CI, 0.54-0.95]). Among the 1,734 participants with OLD, 1,054 (60.8%) died during median follow-up of 12 years. In an adjusted model, Mexican Americans had no advantage in mortality from all causes (HR, 0.88 [95% CI, 0.69-1.13]). After accounting for the fact that some Mexican Americans may have moved back to Mexico and died there (thus, had no US death certificate), there was still no difference in mortality between these groups.


CONCLUSIONS
Although Mexican Americans appear to have lower risk for OLD, subjects of this ethnicity with OLD do not seem to have a survival advantage.
Division of Pulmonary and Critical Care Medicine (Drs Diaz, Come, Pinto-Plata, Divo, Celli, and Washko)Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: ADiaz6@partners.org.
Alejandro A
AA
Diaz
Division of Pulmonary and Critical Care Medicine (Drs Diaz, Come, Pinto-Plata, Divo, Celli, and Washko)Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Carolyn E
CE
Come
Division of Pulmonary, Sleep, and Critical Care Medicine, University of Kentucky College of Medicine, Lexington, KY; University of Kentucky College of Public Health, Lexington, KY.
David M
DM
Mannino
Division of Pulmonary and Critical Care Medicine (Drs Diaz, Come, Pinto-Plata, Divo, Celli, and Washko)Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Victor
V
Pinto-Plata
Division of Pulmonary and Critical Care Medicine (Drs Diaz, Come, Pinto-Plata, Divo, Celli, and Washko)Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Miguel J
MJ
Divo
Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA.
Carol
C
Bigelow
Division of Pulmonary and Critical Care Medicine (Drs Diaz, Come, Pinto-Plata, Divo, Celli, and Washko)Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Bartolome
B
Celli
Division of Pulmonary and Critical Care Medicine (Drs Diaz, Come, Pinto-Plata, Divo, Celli, and Washko)Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
George R
GR
Washko
D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality*; D008297:Male; D017058:Mexican Americans / Q000208:ethnology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D012923:Social Class; D015996:Survival Rate; D014481:United States; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*