Abstract
Low socioeconomic status has been associated with chronic obstructive pulmonary disease (COPD) but little is known about its impact on disease progression. We assessed the association of income to symptoms, pulmonary disease severity and progression in smokers with and without COPD.
The COPDGene cohort of 4826 smokers who reported annual income in phase 2 was analysed. Those who reported annual income <USD 15 000 per year were “low-income” and the remainder “higher income”. Baseline demographics, symptoms, computed tomography (CT) imaging, and 5-year change in spirometry and CT metrics were characterised by group.
The low income group was younger (55.7 versus 61.7, p<0.0001), had more current smokers (73% versus 36%, p<0.0001), higher rates of severe exacerbations (13% versus 7%, p<0.0001), more chronic bronchitis (22% versus 14%, p<0.0001), reduced access to preventative care and lower quality of life, but less emphysema (4.7% versus 6.2%, p<0.0001). After 5 years the low-income group had more smoking-related disease progression, without significant change in exacerbations or symptoms, than higher-income subjects. Low income was an independent predictor of decreasing forced expiratory volume in 1 s (FEV1) (p=0.001) and increased airway disease (p=0.007) after adjusting for baseline FEV1, age, sex, race, exposures and current smoking.
Income disparity beyond the effects of race and current smoking is an important factor for disease progression. Worldwide, poverty and its consequences: associated respiratory exposures, limited healthcare access, and inadequate education about smoking risks, may exacerbate chronic lung disease.
Abstract
Income is a factor in predicting pulmonary disease progression in smokers with and without COPD; those with lower income experience faster progression and worse symptoms http://ow.ly/1SSe30lU1cX
Footnotes
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Author contributions: Concept: K.E. Lowe, E.A. Regan, J.D. Crapo and B.J. Make; data analysis: K.E. Lowe and E.A. Regan; manuscript development: K.E. Lowe, B.J. Make, J.D. Crapo, G.L. Kinney, J.E. Hokanson, V. Kim, A.S. Iyer, S.P. Bhatt, K.F. Hoth, K.E. Holm, R. Wise, M.G. Foreman, T.J. Stone and E.A. Regan; manuscript writing and editing: K.E. Lowe, B.J. Make, J.D. Crapo, J.E. Hokanson, G.L. Kinney, V. Kim, A.S. Iyer, S.P. Bhatt, K.F. Hoth, K.E. Holm, R. Wise, D. DeMeo, M.G. Foreman, T.J. Stone and E.A. Regan.
Conflict of interest: K.E. Lowe has nothing to disclose.
Conflict of interest: B.J. Make reports grants and personal fees from AstraZeneca (international PI for multicentre clinical trial, medical advisory board, disease-state presentation, grant funds provided to and controlled by National Jewish Health); support from Spiration (reviewed clinical trial data, data and safety monitoring board); grants, personal fees and other support from GlaxoSmithKline (advisory board member, disease-state presentation, multicentre trial funds provided to and controlled by National Jewish Health); grants, personal fees and other support from Sunovian (medical board member, grant funds provided to and controlled by National Jewish Health); support for CME activity from Consensus Medical Education, Integrity Medical Education, Mt Sinai Medical Center, Web MD, Up-To-Date, National Jewish Health, SPIRE Learning, the American College of Chest Physicians, Projects in Knowledge, Hybrid Communications, Peer Review Institute, Cleveland Clinic, Medscape and Ult Medical Academy; personal fees from Novartis (medical advisory board, consultant); grants from National Heart, Lung and Blood Institute (grant funds provided to and controlled by National Jewish Health); personal fees from CSL Bering, Verona, Boehringer Ingelheim, Theravance and Circassia (medical advisory boards); and grants from Pearl (research funds provided to and controlled by National Jewish Health), all outside the submitted work.
Conflict of interest: J.D. Crapo has nothing to disclose.
Conflict of interest: G.L. Kinney has nothing to disclose.
Conflict of interest: J.E. Hokanson has nothing to disclose.
Conflict of interest: V. Kim reports personal fees from Medscape (peer reviewer), Gala Therapeutics (advisory board) and ABIM Critical Care Testwriting Committee (chairman), and grants from NHLBI (K23HL094696), outside the submitted work.
Conflict of interest: A.S. Iyer reports grants from the Agency for Healthcare Research and Quality (K12 HS023009), outside the submitted work.
Conflict of interest: S.P. Bhatt reports grants from NIH (K23HL133438) and ProterixBio (research grant to institution), during the conduct of the study.
Conflict of interest: K.F. Hoth has nothing to disclose.
Conflict of interest: K.E. Holm reports personal fees from AlphaNet, outside the submitted work.
Conflict of interest: R. Wise reports grants from AstraZeneca/Medimmune, Boehringer Ingelheim, Teva, Pearl Therapeutics and GSK; and personal fees from AstraZeneca/Medimmune (data monitoring committee and consulting), Boehringer Ingelheim (steering committee and data monitoring committee), Contrafect (clinical end-point committee), Pulmonx (data safety monitoring committee), Roche (data monitoring committee), Spiration (steering committee), Sunovion (workshop and consulting), Teva, Circassia, Pneuma, Verona, Aradigm and Dinali (all for consulting), Merck (data monitoring committee), GSK (data monitoring committee and consulting) and Bonti (safety review committee), all outside the submitted work. Conflicts of interest for R. Wise are reported to and managed by Johns Hopkins University School of Medicine.
Conflict of interest: D. DeMeo reports personal fees from Novartis and grants from NIH, outside the submitted work.
Conflict of interest: M.G. Foreman has nothing to disclose.
Conflict of interest: T.J. Stone has nothing to disclose.
Conflict of interest: E.A. Regan has nothing to disclose.
Support statement: The project described was supported by award number U01 HL089897 and award number U01 HL089856 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. The COPDGene project is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Siemens and Sunovion. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received May 21, 2018.
- Accepted September 11, 2018.
- Copyright ©ERS 2018
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