title: Chronic obstructive pulmonary disease and subsequent overall and lung cancer mortality in low-income adults.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a known risk factor for lung cancer and a leading cause of mortality in the U.S., but its impact may not be fully appreciated, especially among low-income populations in the southeast where COPD prevalence and lung cancer incidence are elevated.
  
  
  METHODS
  We conducted a prospective study among 26,927 low-income adults age 40-79 in the Southern Community Cohort Study who had a Center for Medicare and Medicaid Services (CMS) encounter prior to enrollment and were followed for a median of over 6 years. Using a validated algorithm for assessing COPD from CMS claims data, we estimated COPD prevalence and potential misreporting. From Cox proportional hazard models, we computed overall and lung cancer-specific mortality according to COPD status.
  
  
  RESULTS
  The overall prevalence of CMS-diagnosed COPD was 16%, but was twice as high among whites as blacks. Only 35% of these individuals, however, self-reported having COPD, with underreporting significantly greater for blacks than whites. Smoking-adjusted all-cause mortality was increased by 1.7-fold and lung cancer mortality by 2.3-fold among those with a CMS COPD diagnosis, with similar patterns in blacks and whites, but no excess was found among those self-reporting COPD and without CMS confirmation.
  
  
  CONCLUSIONS
  The prevalence of COPD in this low-income population may be greater than previously recognized and misreporting is common. COPD is associated with elevated lung cancer mortality, even among those not self-reporting the condition.
authors: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.
authors: Melinda C
authors: MC
authors: Aldrich
authors: International Epidemiology Institute, Rockville, MD, United States of America.
authors: Heather M
authors: HM
authors: Munro
authors: International Epidemiology Institute, Rockville, MD, United States of America.
authors: Michael
authors: M
authors: Mumma
authors: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America; Tennessee Valley Health System Veterans Affairs, Nashville, TN, United States of America.
authors: Eric L
authors: EL
authors: Grogan
authors: Division of Pulmonary and Critical Care Medicine, Thoracic Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States of America.
authors: Pierre P
authors: PP
authors: Massion
authors: Departments of Medicine, Cell and Development Biology, and Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, United States of America.
authors: Timothy S
authors: TS
authors: Blackwell
authors: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; International Epidemiology Institute, Rockville, MD, United States of America.
authors: William J
authors: WJ
authors: Blot
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American