COPD in a Population-Based Sample of Never-Smokers: Interactions among Sex, Gender, and Race

Abstract

This observational epidemiological study investigates sex/gender and racial differences in prevalence of COPD among never-smokers. Data were derived from the 2012 Center for Disease Control's Behavioral Risk Factor Surveillance System. The sample consisted of 129,535 non-Hispanic whites and blacks 50 years of age and older who had never smoked. Descriptive and multivariable analyses were conducted, with the latter using a series of logistic regression models predicting COPD status by sex/gender and race, adjusting for age, height, socioeconomic position (SEP), number of household members, marital status, and health insurance coverage. Black women have the highest prevalence of COPD (7.0%), followed by white women (5.2%), white men (2.9%), and black men (2.4%). Women have significantly higher odds of COPD than men. When adjusting for SEP, black and white women have comparably higher odds of COPD than white men (black women OR = 1.66; 99% CI = 1.46, 1.88; white women OR = 1.49; 99% CI = 1.37, 1.63), while black men have significantly lower odds (OR = 0.62; 99% CI = 0.49, 0.79). This research provides evidence that racial inequalities in COPD (or lack thereof) may be related to SEP.

Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

“…For example, among young women with low education and low income that lived alone, intersectional interaction may explain why natives had higher incidence of COPD than immigrants. A previous study using a fixed effects approach found interactions between gender and race in the USA ( Fuller-Thomson, Chisholm & Brennenstuhl, 2016 ). Also, a study of lung cancer mortality in the USA with an explicit intersectional approach comprising gender, race, income and education found that black men had a higher mortality risk than white men but black women had markedly lower mortality risk than white women ( Williams et al, 2012 ).…”

Chronic obstructive pulmonary disease in non-smokers - Is it a different phenotype?

“…Histopathologically, airways of patients with COPD due to biomass fuel smoke show more significant changes of bronchitis and fibrosis, increased eosinophilic component, anthracotic pigment deposition, thickening of airway walls and vascular endothelium 25 26 27 . Non-smoker COPD patients were more commonly women who predominantly presented with symptoms of CB 27 . A Tunisian population-based study reports significantly more symptoms and co-morbid conditions in COPD in non-smokers 28 .…”

The association between risk factors and chronic obstructive pulmonary disease in Canada: A cross-sectional study using the 2014 canadian community health survey

“…Some demographic risk factors for COPD include sex,[ 13 ] age,[ 2 3 ] cultural/racial origin,[ 14 15 ] and immigrant status. [ 16 ] The prevalence of COPD in women has increased in the recent years.…”

“…[ 2 ] Initially, many studies reported a cultural/racial difference in COPD prevalence. [ 14 15 ] However, this association is often attributed to an underlying risk factor, such as socioeconomic status (SES). [ 14 15 ] Similarly to other chronic diseases, immigrant status is negatively associated with COPD, leaving the majority of the Canadian-born population at a higher risk of COPD.…”

“…[ 18 ] Likewise, lower education has been associated with deteriorating lung function[ 19 ] and increased severity of COPD. [ 15 23 ]…”