Race and Gender Influence Diagnosis of COPD

ATS 2013, PHILADELPHIA – African-Americans are less likely than whites and women are more likely than men to have had a prior diagnosis of chronic obstructive pulmonary disease (COPD) regardless of their current disease severity, according to a new study.

“Race and gender are known to affect the diagnosis and treatment of a number of diseases,” said lead author Albert Mamary, MD, Assistant Professor of Medicine at the Temple University School of Medicine in Philadelphia. “In our study of almost 9,000 patients enrolled in the COPDGene study, a cross sectional sample of high risk patients, race and gender were associated with significant disparities in the prevalence of prior COPD diagnosis across all stages of actual current disease severity.”

The results of the study will be presented at the ATS 2013 International Conference.

The COPDGene study enrolled white (non-Hispanic) and African-American subjects 45 years of age or older with a history of at least 10 pack years of cigarette smoking (pack years are calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked). Baseline assessment included spirometry (a test of lung function) and determination of prior COPD diagnosis with the questions “do you have COPD?”, “do you have emphysema?” and “do you have chronic bronchitis?”

Disease severity was measured using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system, which classifies COPD patients based on their degree of airflow obstruction as having mild (Stage 1), moderate (stage 2), severe (stage 3), or very severe (stage 4) COPD.

Compared with whites, African-American subjects at all GOLD stages of airflow obstruction had significantly higher odds of not having had a prior COPD diagnosis Compared with men, women at all GOLD stages has significantly higher odds of having had a prior COPD diagnosis.

At Gold stages 0, 1, 2, 3, and 4, the odds of not having a prior COPD diagnosis among African-Americans vs. whites were 1.6, 1.6, 1.9, 3.3, and 3.7, respectively. The odds of having a prior COPD diagnosis among women vs. men were 1.9, 1.4, 1.6, 1.0, and 1.1 at Gold stages 0, 1, 2, 3, and 4, respectively.

“The underdiagnosis and potential undertreatment of COPD among African Americans that we detected in our study is cause for concern,” said Dr. Mamary. “Future research should focus on the factors underlying the race and gender disparities that we found.”

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* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 40801African Americans Are Underdiagnosed With COPD Across All Severities Of Airflow ObstructionType: Scientific AbstractCategory: 02.03 - Disparities in Lung Disease and Treatment (BSHSR)Authors: A.J. Mamary1, J.I. Stewart1, G.L. Kinney2, J.E. Hokanson2, K.V. Shenoy1, M.T. Dransfield3, M.G. Foreman4, G.B. Vance1, G.J. Criner1; 1Temple University School of Medicine - Philadelphia, PA/US, 2University of Colorado Anschutz Medical Campus - Aurora, CO/US, 3University of Alabama Birmingham - Birmingham, AL/US, 4Morehouse School of Medicine - Atlanta, GA/US; COPDGene Investigators

Abstract BodyRationale: COPDGene provides a rich cross sectional dataset of patients with substantial tobacco smoke exposure and varied race, gender, history of COPD diagnosis, and severity of illness. Aim: Determine the influence of race, gender and GOLD Stage at COPDGene enrollment on the prevalence of prior COPD diagnosis in at-risk patients in the US. Methods: Data from complete phase 1 cohort of 10,120 subjects were analyzed. Subjects were White (non-Hispanic) and African-American 45 years old with 10 pack years cigarette smoking. Characterization at enrollment included spirometry, demographics and prior COPD diagnosis determined by “yes” response to any of these three written questions “do you have COPD?”, “do you have emphysema?”, “do you have chronic bronchitis?” We evaluated individually the effects of race and gender on likelihood of prior diagnosis of COPD and the interaction of race and GOLD stage, and gender and GOLD stage as determined at study enrollment on likelihood of prior diagnosis of COPD. Finally we evaluated the three-way interaction of race, gender and GOLD stage on prior diagnosis. Data were analyzed by logistic regression and multiple logistic regression and trend analysis using SAS 8.3 software. Results: N=10,120. Excluded from this analysis N=1,092 with restrictive ventilatory defect (FEV1/FVC >70 with an FEV1 < 70%). Included N=8908. Baseline characteristics are shown in Table 1. Odds ratio of prior diagnosis of COPD by race and gender at each current GOLD stage is shown in Table 2. African-Americans had significantly higher odds of not having a prior COPD diagnosis at all GOLD stages of airflow obstruction vs. Whites (p<0.0001). (Linear Trend statistic p<0001). Women had higher odds of having a prior COPD diagnosis at all GOLD stages vs. men (p<0.0001). (Linear Trend statistic p<0001). Three-way interaction of race, gender and GOLD stage was not significant. Summary: Prior to study enrollment African-Americans were less likely than Whites to have been diagnosed with COPD regardless of the severity of airflow obstruction determined at study enrollment. Prior to study enrollment Women were more likely than men to have COPD diagnosis regardless of severity of airflow obstruction determined at study enrollment even in the absence of actual airflow obstruction. Conclusion: Race and gender are associated with significant disparities in prevalence of COPD diagnosis in high risk patients across all GOLD stages of actual airflow obstruction.