Chronic obstructive pulmonary disease and subsequent overall and lung cancer mortality in low-income adults.

Aldrich MC, Munro HM, Mumma M, Grogan EL, Massion PP, Blackwell TS, Blot WJ
PLoS One. 2015 10 (3): e0121805

PMID: 25811837 · PMCID: PMC4374870 · DOI:10.1371/journal.pone.0121805

BACKGROUND - Chronic obstructive pulmonary disease (COPD) is a known risk factor for lung cancer and a leading cause of mortality in the U.S., but its impact may not be fully appreciated, especially among low-income populations in the southeast where COPD prevalence and lung cancer incidence are elevated.

METHODS - We conducted a prospective study among 26,927 low-income adults age 40-79 in the Southern Community Cohort Study who had a Center for Medicare and Medicaid Services (CMS) encounter prior to enrollment and were followed for a median of over 6 years. Using a validated algorithm for assessing COPD from CMS claims data, we estimated COPD prevalence and potential misreporting. From Cox proportional hazard models, we computed overall and lung cancer-specific mortality according to COPD status.

RESULTS - The overall prevalence of CMS-diagnosed COPD was 16%, but was twice as high among whites as blacks. Only 35% of these individuals, however, self-reported having COPD, with underreporting significantly greater for blacks than whites. Smoking-adjusted all-cause mortality was increased by 1.7-fold and lung cancer mortality by 2.3-fold among those with a CMS COPD diagnosis, with similar patterns in blacks and whites, but no excess was found among those self-reporting COPD and without CMS confirmation.

CONCLUSION - The prevalence of COPD in this low-income population may be greater than previously recognized and misreporting is common. COPD is associated with elevated lung cancer mortality, even among those not self-reporting the condition.

MeSH Terms (16)

Adult African Continental Ancestry Group Aged Cohort Studies European Continental Ancestry Group Female Humans Lung Neoplasms Male Middle Aged Multivariate Analysis Poverty Proportional Hazards Models Pulmonary Disease, Chronic Obstructive Risk Factors United States

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