title: Socioeconomic Characteristics Are Major Contributors to Ethnic Differences in Health Status in Obstructive Lung Disease: An Analysis of the National Health and Nutrition Examination Survey 2007-2010.
abstract: BACKGROUND
  Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors.
  
  
  METHODS
  We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV₁/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS.
  
  
  RESULTS
  Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites.
  
  
  CONCLUSIONS
  Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.
authors: Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI. Electronic address: carlosma@umich.edu.
authors: Carlos H
authors: CH
authors: Martinez
authors: Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, KY; Department of Epidemiology, Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY.
authors: David M
authors: DM
authors: Mannino
authors: Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI.
authors: Jeffrey L
authors: JL
authors: Curtis
authors: Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI.
authors: MeiLan K
authors: MK
authors: Han
authors: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Alejandro A
authors: AA
authors: Diaz
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D009749:Nutrition Surveys; D012959:Socioeconomic Factors; D013147:Spirometry; D014481:United States / Q000453:epidemiology; D044465:White People
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