Socioeconomic Status and Its Relationship to Chronic Respiratory Disease

Abstract

Socioeconomic status (SES) is defined as an individual's social or economic standing, and is a measure of an individual's or family's social or economic position or rank in a social group. It is a composite of several measures including income, education, occupation, location of residence or housing. Studies have found a lower SES has been linked to disproportionate access to health care in many diseases. There is emerging data in pulmonary diseases such as COPD, asthma, cystic fibrosis, pulmonary hypertension and other chronic respiratory conditions that allude to a similar observation noted in other chronic diseases. In the setting of COPD, SES has an inverse relationship with COPD prevalence, mortality, health utilization costs and HRQoL. Asthma and cystic fibrosis show an increased severity and hospitalizations in relationship to a lower SES. Similar observations were seen in sarcoidosis, PHTN and obstructive sleep apnea. There remains a limited data on non-CF bronchiectasis and interstitial lung diseases. Population SES may be gauged by various measures such as education, occupation, marital status but no value is more indicative than income. Currently guidelines and management algorithms do not factor the effect of SES in the disease process. Despite the great amount of data available, a standardized method must be created to include SES in the prognostic calculations and management of chronic pulmonary diseases.

Impact of the financial crisis on COPD burden: Greece as a case study

“…This is similar to the results from a Danish study, which found that university graduates and people with ⩾10 years of education presented lower rates of disease compared to those with <10 years of education [51]. In particular, a significant interplay seems to exist between COPD and socioeconomic status [52][53][54][55][56][57]. A significant negative correlation between lung function ( primarily forced expiratory volume in 1 s and forced vital capacity) and socioeconomic status has been established [54].…”

“…A relationship exists even after adjusting for smoking status, occupational exposure and race [54]. Smoking is associated with a greater absolute mortality risk due to lung cancer or COPD for individuals in lower socioeconomic groups [55][56][57][58]. Income is inversely associated with COPD treatment initiation [57].…”

Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies

“…Asthma appears to be a major underlying risk factor for COPD evidenced by the finding that up to 30% of COPD patients are asthmatics (Soriano et al, 2003) and that a more rapid decline in lung function is observed in smokers with asthma than those without (Lange, Parner, Vestbo, Schnohr, & Jensen, 1998). Finally, population groups with poorer social-economic status tend to have a greater risk of developing COPD and its complications than their wealthier counterparts (Fragoso, 2016;Lawlor, Ebrahim, & Davey Smith, 2004;Sahni, Talwar, Khanijo, & Talwar, 2017;Shohaimi et al, 2004), which is likely to be related to poor nutritional status, living standard, exposure to pollutants and high smoking rate along with poor access to health care.…”

Trends in prevalence and incidence of chronic respiratory diseases from 1990 to 2017

“…It was estimated that the burden of chronic diseases, including CRDs, accounted for 80% of the total burden in developing countries [7]. A negative association of socioeconomic status with the prevalence in COPD was revealed [8]. Asthma prevalence was found to be highest in high-income regions [9].…”