Table 4.
Effect of socioeconomic status on respiratory-related outcomes in chronic obstructive pulmonary disease
| References | Population | SES measure | Outcome measure(s) | Main findings |
|---|---|---|---|---|
| Prescott et al43 | Copenhagen, Denmark general population (N=14,223) | Educational level and household income | Hospitalization for COPD | Higher rates of hospitalization related to income and education levels (independent of smoking history) |
| Van Rossum et al42 | the Netherlands (N=18,001) | Occupation | Mortality | COPD had highest rate of increased mortality related to occupation compared with other common causes of death |
| Steenland et al11 | Adults in 27 states in the US, American Cancer Society population (N=1,330,886) | Occupation | All cause and cause-specific mortality | SES gradient most substantial for all specific causes of death |
| Huisman et al44 | European data from numerous countries (N=1,000,000 deaths) | Education level | Mortality rate in low-educational groups expressed as a proportion of mortality rate in high-educational groups | Low education groups had highest mortality including COPD, cancer, and heart disease |
| Antonelli-Incazi et al45 | Elderly in Rome, Italy | Income based upon census tract estimate for residence | Hospitalization rate of COPD | Relative risk for females with COPD 3.3 and males 4.3 (higher than other diseases) |
| Blanc et al46 | US population survey of COPD patients (N=427) | Educational level and annual income | Tiotropium use | Less use of tiotropium with lower SES (OR =0.3) |
| Reilly et al47 | National survey of 30 provinces in the People’s Republic of China (N=169,871) | Education, residence (urban vs rural) | Mortality | Relative risk of death 2.37 and 2.47 for men and women, respectively. RR for urban vs rural residence 2.14 and 1.79, respectively |
| Schane et al48 | National cross-sectional US survey (N=18,858 total N=1,736 COPD patients) | Income and education | Risk factors for depression in COPD vs non-COPD | Less than HS education showed OR =1.63 for depression |
| Wong et al49 | Data from St Paul’s Hospital in Vancouver, BC, Canada | Marital status and need for social work consultation while in hospital | Hospital LOS and readmission rate in AECOPD patients | Marital status and need for social work intervention associated with prolonged LOS and readmission for AECOPD |
| Lewis et al10 | National Longitudinal Mortality Study in the US (N=184,924) | Marital status, education, health insurance, poverty level, and occupation | Mortality in a general adult population | Education, marital status, and income predictive of mortality, not seen with insured vs uninsured |
| Arne et al50 | Sweden, survey of 55 municipalities (N=1,475) | Education level, employment status, and social support | Health status and quality of life in COPD vs non-COPD subjects | Lack of social support and low economic status associated with poorer health status in COPD |
| Calderón-Larrañaga et al51 | UK, national cross-sectional study (N=53,676,021) | Deprivation index | Hospitalizations for COPD | Deprivation and smoking prevalence were variables with highest explanatory power, accounting for 59.3% and 51.4% of the total variance, respectively |
| Miravitlles et al52 | Spain, nationwide survey (N=4,574) | Education level and occupation | HrQOL in COPD patients | Worse HrQOL in low education level and in unskilled workers |
| Eisner et al31 | CA, in the US (N=1,202) (insured COPD patients) | Education and income levels | Physical impairment (6-minute walk), pulmonary function, and disease severity including BODE index | Low SES associated with worse physical impairment, pulmonary, function, and disease severity in a COPD population with broad access to health care |
| Omachi et al53 | CA, in the US, population survey in persons >55 years (N=277) | Health literacy | COPD-related health status and COPD-related ED or hospitalizations using multifactorial analysis adjusted for income and educational levels | Poorer health literacy associated with worse health status, HrQOL, and ED and hospitalizations for COPD |
| McAllister et al54 | All Scottish residents (UK) | Scottish Index of Multiple Deprivation (measure using multiple domains such as income, housing, access, education) | Hospitalization rates in COPD associated with deprivation index and winter season | SES and winter act synergistically on rate of COPD hospitalizations |
| Gershon et al55 | ON, Canada | Average household income based on residence | Mortality of COPD | Although overall COPD mortality decreased between 1966 and 2012, differences in COPD mortality between low and high income widened over the study period |
| Lange et al56 | Copenhagen, Denmark (N=6,590) adults with COPD | Education <8 years, 8–10 years, >10 years with some college or completed college | AECOPD, hospital admissions, mortality | Highest risk of AECOPD, low lung function, and highest respiratory symptoms |
| Trachtenberg et al57 | Administrative database in Winnipeg, Canada N=34,741 asthma and COPD) | Census-based household income | Hospitalizations for asthma or COPD | Lower SES associated with higher risk of hospitalizations |
| Sharma et al58 | US Medicare beneficiaries with COPD | Socioeconomic status based on if Medicaid eligible (low SES) | Burn injuries related to oxygen use | Twofold risk of oxygen-related burn injuries in low SES people |
Abbreviations: AECOPD, acute exacerbation of COPD; COPD, chronic obstructive pulmonary disease; ED, emergency department; HrQOL, health-related quality of life; LOS, length of stay; OR, odds ratio; RR, relative risk; SES, socioeconomic status.