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PLoS One. 2015 Mar 26;10(3):e0121805. doi: 10.1371/journal.pone.0121805. eCollection 2015.

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

Author information

1
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America.
2
International Epidemiology Institute, Rockville, MD, United States of America.
3
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America; Tennessee Valley Health System Veterans Affairs, Nashville, TN, United States of America.
4
Division of Pulmonary and Critical Care Medicine, Thoracic Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States of America.
5
Departments of Medicine, Cell and Development Biology, and Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, United States of America.
6
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; International Epidemiology Institute, Rockville, MD, United States of America.

Abstract

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.

PMID:
25811837
PMCID:
PMC4374870
DOI:
10.1371/journal.pone.0121805
[Indexed for MEDLINE]
Free PMC Article

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