Racial Differences in Quality of Life in Patients With COPD

Abstract

Multiple studies have demonstrated signifi cant impairment in the health-related quality of life (HRQL) in subjects with COPD. 1 The concept of HRQL relates to disparity between an individual's desired and real-life well being as infl uenced by his or her health. 2 Many factors have been reported to infl uence HRQL in COPD, including lung function, exercise capacity, depression, and level of education. 3,4 Little has been published, however, regarding the infl uence of race on HRQL. Until recently, many clinical trials have failed to enroll adequate numbers of African Americans to allow such an evaluation.Data demonstrate both an increasing prevalence of COPD among African Americans and a signifi cant increase in mortality. 5 There is also reason to believe that tobacco susceptibility 6 and response to inhaled therapies 7 may differ between African American and Caucasian subjects. Racial disparities in the treatment Background: Although COPD is associated with signifi cant health-related quality-of-life (HRQL) impairment, factors infl uencing HRQL in patients with COPD are not well understood, particularly in African Americans. We hypothesized that HRQL in COPD differs by race and sought to identify factors associated with those differences. Methods: We analyzed 224 African American and 1,049 Caucasian subjects with COPD enrolled in the COPDGene (Genetic Epidemiology of COPD) Study whose conditions were classifi ed as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to IV. HRQL and symptoms were compared using the St. George Respiratory Questionnaire (SGRQ) and the modifi ed Medical Research Council Dyspnea (MMRC) scale. We constructed a mixed-effects linear regression model for SGRQ score. Results: African Americans were younger and reported fewer pack-years of smoking, more current smoking, and less attained education than Caucasians; MMRC scores were higher ( P 5 .02) as were SGRQ scores (mean score difference, 8.4; P , .001). In a general linear model of SGRQ total score after adjusting for factors such as age, sex, and pack-years of smoking, SGRQ total score was similar for African Americans and Caucasians who reported no COPD exacerbations in the prior year. However, for subjects with exacerbations, SGRQ total score was increased to a greater relative extent for African Americans than for Caucasians (1.89 points for each exacerbation, P 5 .006). For hospitalized exacerbations, the effect on SGRQ total score also was greater for African Americans (4.19 points, P 5 .04). Furthermore, a larger percentage of African Americans reported having had at least one exacerbation that required hospitalization in the prior year (32% vs 16%, P , .001). Conclusion

Racial Differences in CT Phenotypes in COPD

“…Similar to comparisons presented between the AA and NHW participants with GOLD Stage I-IV (22), AA participants were younger, more likely to be current smokers, smoked less than NHWs, but had similar levels of lung function impairment. AAs were also more likely to carry a diagnosis of asthma and to have held a dusty job (Table 1).…”

Socioeconomic Characteristics Are Major Contributors to Ethnic Differences in Health Status in Obstructive Lung Disease

“…Th ese fi ndings illustrate the complexity of the ethnic diff erences in disease impact in OLD, which are present not just between non-Hispanic whites and Mexican Americans but also between non-Hispanic whites and African Americans because it has been proven by other researchers. For example, in analyses comparing non-Hispanic whites and African Americans with COPD in the COPDGene (Genetic Epidemiology of COPD) cohort, Han et al 5 found similar HR-QOL in the absence of exacerbations but worse HR-QOL for African Americans who had experienced exacerbations. In the present analyses, we tried to advance the current knowledge to identify possible casual pathways of poorer HS in Mexican Americans with OLD.…”

“…Comparisons of racial diff erences in HR-QOL in patients who have experienced exacerbations of COPD showed worse HR-QOL in African Americans . 5 However, minimal research has been done on diff erences in HR-QOL in other racial or ethnic groups with OLD.…”

Health Disparities in Asthma

“…African Americans and Puerto Ricans share both a significant proportion of African ancestry and a high burden from lung diseases such as asthma and chronic obstructive pulmonary disease (12). Whereas African ancestry has been associated with reduced FEV 1 and FVC in African American adults without asthma (13) and Puerto Rican children (with and without asthma) (14), Native American ancestry has been associated with higher FEV 1 and reduced risk of chronic obstructive pulmonary disease in adults from New Mexico (15).…”

“…Work in animal models of inflammation-induced airway remodeling demonstrates an increase in the fraction of ASM within the airway showing markers of cell cycle progression (i.e., proliferation). However, several studies have reported that ASM cells of individuals with severe asthma do not show increased frequency of expression of cell cycle progression markers, such as cyclin D1 and proliferating cell nuclear antigen (PCNA) in post mortem specimens (12), or in biopsies, measuring either cyclin D1 (2) or Ki67 (13). A more recent biopsy study reports increases in Ki67 and proliferating cell nuclear antigen frequency in severe asthma (14).…”