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ERJ Open Res. 2018 Nov 12;4(4). pii: 00069-2018. doi: 10.1183/23120541.00069-2018. eCollection 2018 Oct.

Association of low income with pulmonary disease progression in smokers with and without chronic obstructive pulmonary disease.

Author information

1
Dept of Medicine, National Jewish Health, Denver, CO, USA.
2
Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
3
Dept of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA, USA.
4
Dept of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
5
Dept of Psychiatry, University of Iowa, Iowa City, IA, USA.
6
Dept of Medicine, Johns Hopkins University, Baltimore, MD, USA.
7
Dept of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
8
Morehouse School of Medicine, Atlanta, GA, USA.
9
Brigham Young University, Provo, UT, USA.

Abstract

Low socioeconomic status has been associated with chronic obstructive pulmonary disease (COPD) but little is known about its impact on disease progression. We assessed the association of income to symptoms, pulmonary disease severity and progression in smokers with and without COPD. The COPDGene cohort of 4826 smokers who reported annual income in phase 2 was analysed. Those who reported annual income <USD 15 000 per year were "low-income" and the remainder "higher income". Baseline demographics, symptoms, computed tomography (CT) imaging, and 5-year change in spirometry and CT metrics were characterised by group. The low income group was younger (55.7 versus 61.7, p<0.0001), had more current smokers (73% versus 36%, p<0.0001), higher rates of severe exacerbations (13% versus 7%, p<0.0001), more chronic bronchitis (22% versus 14%, p<0.0001), reduced access to preventative care and lower quality of life, but less emphysema (4.7% versus 6.2%, p<0.0001). After 5 years the low-income group had more smoking-related disease progression, without significant change in exacerbations or symptoms, than higher-income subjects. Low income was an independent predictor of decreasing forced expiratory volume in 1 s (FEV1) (p=0.001) and increased airway disease (p=0.007) after adjusting for baseline FEV1, age, sex, race, exposures and current smoking. Income disparity beyond the effects of race and current smoking is an important factor for disease progression. Worldwide, poverty and its consequences: associated respiratory exposures, limited healthcare access, and inadequate education about smoking risks, may exacerbate chronic lung disease.

Conflict of interest statement

Conflict of interest: K.E. Lowe has nothing to disclose. Conflict of interest: B.J. Make reports grants and personal fees from AstraZeneca (international PI for multicentre clinical trial, medical advisory board, disease-state presentation, grant funds provided to and controlled by National Jewish Health); support from Spiration (reviewed clinical trial data, data and safety monitoring board); grants, personal fees and other support from GlaxoSmithKline (advisory board member, disease-state presentation, multicentre trial funds provided to and controlled by National Jewish Health); grants, personal fees and other support from Sunovian (medical board member, grant funds provided to and controlled by National Jewish Health); support for CME activity from Consensus Medical Education, Integrity Medical Education, Mt Sinai Medical Center, Web MD, Up-To-Date, National Jewish Health, SPIRE Learning, the American College of Chest Physicians, Projects in Knowledge, Hybrid Communications, Peer Review Institute, Cleveland Clinic, Medscape and Ult Medical Academy; personal fees from Novartis (medical advisory board, consultant); grants from National Heart, Lung and Blood Institute (grant funds provided to and controlled by National Jewish Health); personal fees from CSL Bering, Verona, Boehringer Ingelheim, Theravance and Circassia (medical advisory boards); and grants from Pearl (research funds provided to and controlled by National Jewish Health), all outside the submitted work. Conflict of interest: J.D. Crapo has nothing to disclose. Conflict of interest: G.L. Kinney has nothing to disclose. Conflict of interest: J.E. Hokanson has nothing to disclose. Conflict of interest: V. Kim reports personal fees from Medscape (peer reviewer), Gala Therapeutics (advisory board) and ABIM Critical Care Testwriting Committee (chairman), and grants from NHLBI (K23HL094696), outside the submitted work. Conflict of interest: A.S. Iyer reports grants from the Agency for Healthcare Research and Quality (K12 HS023009), outside the submitted work. Conflict of interest: S.P. Bhatt reports grants from NIH (K23HL133438) and ProterixBio (research grant to institution), during the conduct of the study. Conflict of interest: K.F. Hoth has nothing to disclose. Conflict of interest: K.E. Holm reports personal fees from AlphaNet, outside the submitted work. Conflict of interest: R. Wise reports grants from AstraZeneca/Medimmune, Boehringer Ingelheim, Teva, Pearl Therapeutics and GSK; and personal fees from AstraZeneca/Medimmune (data monitoring committee and consulting), Boehringer Ingelheim (steering committee and data monitoring committee), Contrafect (clinical end-point committee), Pulmonx (data safety monitoring committee), Roche (data monitoring committee), Spiration (steering committee), Sunovion (workshop and consulting), Teva, Circassia, Pneuma, Verona, Aradigm and Dinali (all for consulting), Merck (data monitoring committee), GSK (data monitoring committee and consulting) and Bonti (safety review committee), all outside the submitted work. Conflicts of interest for R. Wise are reported to and managed by Johns Hopkins University School of Medicine. Conflict of interest: D. DeMeo reports personal fees from Novartis and grants from NIH, outside the submitted work. Conflict of interest: M.G. Foreman has nothing to disclose. Conflict of interest: T.J. Stone has nothing to disclose. Conflict of interest: E.A. Regan has nothing to disclose.

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