Chest
Volume 140, Issue 5, November 2011, Pages 1169-1176
Journal home page for Chest

Original Research
Obstructive Lung Diseases
Racial Differences in Quality of Life in Patients With COPD

https://doi.org/10.1378/chest.10-2869Get rights and content

Background

Although COPD is associated with significant health-related quality-of-life (HRQL) impairment, factors influencing HRQL in patients with COPD are not well understood, particularly in African Americans. We hypothesized that HRQL in COPD differs by race and sought to identify factors associated with those differences.

Methods

We analyzed 224 African American and 1,049 Caucasian subjects with COPD enrolled in the COPDGene (Genetic Epidemiology of COPD) Study whose conditions were classified as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to IV. HRQL and symptoms were compared using the St. George Respiratory Questionnaire (SGRQ) and the modified Medical Research Council Dyspnea (MMRC) scale. We constructed a mixed-effects linear regression model for SGRQ score.

Results

African Americans were younger and reported fewer pack-years of smoking, more current smoking, and less attained education than Caucasians; MMRC scores were higher (P = .02) as were SGRQ scores (mean score difference, 8.4; P < .001). In a general linear model of SGRQ total score after adjusting for factors such as age, sex, and pack-years of smoking, SGRQ total score was similar for African Americans and Caucasians who reported no COPD exacerbations in the prior year. However, for subjects with exacerbations, SGRQ total score was increased to a greater relative extent for African Americans than for Caucasians (1.89 points for each exacerbation, P = .006). For hospitalized exacerbations, the effect on SGRQ total score also was greater for African Americans (4.19 points, P = .04). Furthermore, a larger percentage of African Americans reported having had at least one exacerbation that required hospitalization in the prior year (32% vs 16%, P < .001).

Conclusion

In analyses that account for other variables that affect quality of life, HRQL is similar for African Americans and Caucasians with COPD without exacerbations but worse for African Americans who experience exacerbations, particularly hospitalized exacerbations.

Trial registry

ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov

Section snippets

Patient Selection

The COPDGene Study (www.copdgene.org) is an ongoing, National Heart, Lung, and Blood Institute-funded multicenter investigation of the genetic epidemiology of smoking-related lung disease and involved recruitment of subjects at 21 clinical centers (e-Appendix 1). Subjects were selected for participation based on the following criteria: aged 45 to 80 years; cigarette smoking ≥ 10 pack-years; and willingness to undergo study-related testing that included spirometry, CT scan of the chest, and

Results

A comparison of baseline demographics by race is shown in Table 1. Eighteen percent of the cohort (224 of 1,273 subjects) were African American. African American subjects in the study were younger than Caucasian subjects (60 vs 65 years, P < .001) but exhibited comparable lung function. African Americans reported fewer pack-years of smoking (54 vs 42, P < .001), significantly shorter 6MWD (381 vs 298 m, P < .001) despite similar height, and less education than Caucasians (P < .001). A greater

Discussion

COPD is an important health problem for African Americans. Death rates for African Americans with COPD increased more rapidly than for Caucasians between 1980 and 2000.18 COPD also has been cited as a predictor of global decline in HRQL in African American middle-aged adults; however, the factors influencing HRQL in this patient population have been underexamined.19 Here, we report that in simple group comparisons, African Americans had worse dyspnea and HRQL than did Caucasians. Our general

Acknowledgments

Author contributions: Drs Han and Foreman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Han: contributed to the data collection, analysis, and writing of the manuscript.

Dr Curran-Everett: contributed primarily to the data analysis and the statistical analysis, drafting, and review of intellectual content of the manuscript.

Dr Dransfield: contributed to the data collection and analysis and

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    • Factors influencing decline in quality of life in smokers without airflow obstruction: The COPDGene study

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      We chose to include race as it has been previously shown to influence QOL decline in participants who have experienced severe exacerbations. Specifically, black participants had a 4.2 higher adjusted SGRQ score for a hospitalized exacerbation compared to white participants [21]. Black participants may also experience racial discrimination as well as have differences in health behaviors including delays in seeking mental health treatment that may affect quality of life [22, 23].

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    Funding/Support: The project was supported by the National Heart, Lung, and Blood Institute [award numbers U01HL089897 and U01HL089856]. The COPDGene project also is supported by the COPD Foundation through contributions made to an industry advisory board comprising AstraZeneca, Boehringer Ingelheim GmbH, Novartis Pharmaceuticals Corporation, and Sepracor Inc. Dr Han is supported by funding from the National Heart, Lung and Blood Institute [Grant K23 HL093351].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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