在所有测量气流阻塞严重程度的慢性阻塞性肺疾病(COPD)漏诊病例中,种族和性别差异明显。

Race and Gender Disparities are Evident in COPD Underdiagnoses Across all Severities of Measured Airflow Obstruction.

作者信息

Mamary A James, Stewart Jeffery I, Kinney Gregory L, Hokanson John E, Shenoy Kartik, Dransfield Mark T, Foreman Marilyn G, Vance Gwendolyn B, Criner Gerard J

机构信息

Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, Pennsylvania.

Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora.

出版信息

Chronic Obstr Pulm Dis. 2018 Jul 2;5(3):177-184. doi: 10.15326/jcopdf.5.3.2017.0145.

Abstract

The COPD Genetic Epidemiology (COPDGene®) study provides a rich cross-sectional dataset of patients with substantial tobacco smoke exposure, varied by race, gender, chronic obstructive pulmonary disease (COPD) diagnosis, and disease. We aimed to determine the influence of race, gender and Global initiative for chronic Obstructive Lung Disease (GOLD) stage on prevalence of prior COPD diagnosis at COPDGene® enrollment. Data from the complete phase 1 cohort of 10,192 participants were analyzed. Participants were non-Hispanic white and African-American, ≥45 years of age with a minimum of 10 pack years of cigarette smoking. Characterization upon enrollment included spirometry, demographics and history of COPD diagnosis determined by questionnaire. We evaluated the effects of race and gender on the 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. We evaluated the 3-way interaction of race, gender and GOLD stage on prior diagnosis. African-Americans had higher odds of not having a prior COPD diagnosis at all GOLD stages of airflow obstruction versus non-Hispanic whites (<0.0001). Women had higher odds of having a prior COPD diagnosis at all GOLD stages versus men (<0.0001). Three-way interaction of race, gender and GOLD stage was not significant. African-Americans were less likely to have prior COPD regardless of the severity of airflow obstruction determined at study enrollment. Women were more likely to have a prior COPD diagnosis regardless of the severity of measured airflow obstruction. Race and gender are associated with significant disparities in COPD diagnosis.

摘要

慢性阻塞性肺疾病基因流行病学(COPDGene®)研究提供了一个丰富的横断面数据集,该数据集涵盖了大量有不同程度烟草烟雾暴露的患者,这些患者在种族、性别、慢性阻塞性肺疾病(COPD)诊断及疾病方面存在差异。我们旨在确定种族、性别以及慢性阻塞性肺疾病全球倡议组织(GOLD)分级对COPDGene®入组时既往COPD诊断患病率的影响。对来自10192名参与者的完整1期队列数据进行了分析。参与者为非西班牙裔白人和非裔美国人,年龄≥45岁,至少有10包年的吸烟史。入组时的特征包括肺功能测定、人口统计学信息以及通过问卷确定的COPD诊断史。我们评估了种族和性别对既往COPD诊断可能性的影响,以及在研究入组时确定的种族与GOLD分级、性别与GOLD分级之间的相互作用对既往COPD诊断可能性的影响。我们评估了种族、性别和GOLD分级对既往诊断的三因素相互作用。在气流受限的所有GOLD分级中,非裔美国人相比非西班牙裔白人,既往未诊断为COPD的几率更高(<0.0001)。在所有GOLD分级中,女性相比男性,既往诊断为COPD的几率更高(<0.0001)。种族、性别和GOLD分级的三因素相互作用不显著。无论在研究入组时确定的气流受限严重程度如何,非裔美国人既往患COPD的可能性较低。无论测量的气流受限严重程度如何,女性既往诊断为COPD的可能性较高。种族和性别与COPD诊断中的显著差异相关。

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