Racial and Ethnic Minorities Have a Lower Prevalence of Airflow Obstruction than Non-Hispanic Whites

Abstract

Racial and ethnic disparities in chronic obstructive pulmonary disease (COPD) are not well-studied. Our objective was to examine differences in limited COPD-related outcomes between three minority groups—African Americans (AAs), Hispanics, and American Indians (AIs) versus non-Hispanic Whites (NHWs), as the referent group, in separate cohorts. Separate cross-sectional evaluations were performed of three US-based cohorts of subjects at risk for COPD: COPDGene Study with 6,884 NHW and 3,416 AA smokers; Lovelace Smokers’ Cohort with 1,598 NHW and 378 Hispanic smokers; and Mining Dust Exposure in the United States Cohort with 2,115 NHW, 2,682 Hispanic, and 2,467 AI miners. Prebronchodilator spirometry tests were performed at baseline visits using standard criteria. The primary outcome was the prevalence of airflow obstruction. Secondary outcomes were self-reported physician diagnosis of COPD, chronic bronchitis, and modified Medical Research Council dyspnea score. All minority groups had a lower prevalence of airflow obstruction than NHWs (adjusted ORs varied from 0.29 in AIs to 0.85 in AAs; p < 0.01 for all analyses). AAs had a lower prevalence of chronic bronchitis than NHWs. In our study, all minority groups had a lower prevalence of airflow obstruction but a greater level of self-reported dyspnea than NHWs, and covariates did not explain this association. A better understanding of racial and ethnic differences in smoking-related and occupational airflow obstruction may improve prevention and therapeutic strategies.

Keywords:

• COPD
• chronic bronchitis
• emphysema
• African Americans
• Hispanic Americans
• American Indians
• miners
• racial and ethnic differences
• spirometric diagnosis of airflow obstruction

Acknowledgments

Guarantor statement: AS takes responsibility for (is the guarantor of) the content of the manuscript, including the data and analysis. Author contributions: AS, HP, RVG, LSC, PM, YT made substantial contributions to the conception or design of the work and CP, OM, XWS, HP made substantial contributions to the acquisition, analysis, or interpretation of data for the work. AS, HP, CL, RVG, LSC, PM, YT, CP, OM, XWS made substantial contribution toward drafting the work or revising it critically for important intellectual content. AS, HP, CL, RVG, LSC, PM, YT, CP, OM, XWS provided the final approval of the version to be published. AS, HP, CL, RVG, LSC, PM, YT, CP, OM, XWS agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by funding by the State of New Mexico (appropriation from the Tobacco Settlement Fund) and the National Institutes of Health (RO1 HL068111 and HL140839 to YT). This work was supported by HRSA (2H1GRH27375, H37RH0057, D04RH31788 to CP, AS). Role of the sponsors: The sponsors played no role in developing the research and manuscript.