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Socioeconomic status, race and COPD health outcomes
  1. M D Eisner1,2,
  2. P D Blanc1,
  3. T A Omachi3,
  4. E H Yelin4,
  5. S Sidney2,
  6. P P Katz4,
  7. L M Ackerson4,
  8. G Sanchez4,
  9. Irina Tolstykh4,
  10. C Iribarren4
  1. 1Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  2. 2Division of Research, Kaiser Permanente, Oakland, California, USA
  3. 3Department of Medicine, Emory University, Atlanta, Georgia, USA
  4. 4Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Mark D Eisner, University of California, San Francisco, 505 Parnassus Avenue, M1097, San Francisco, CA 94143-0111, USA; mark.eisner{at}


Background Although chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race–ethnicity on health outcomes.

Methods The aim of this study is to determine the independent impacts of SES and race–ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD.

Results Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively).

Conclusion Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes.

  • Chronic di
  • respiratory epidem
  • social inequalities

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  • Funding National Heart, Lung, and Blood Institute/National Institutes of Health R01HL077618.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the University of California, San Francisco, and Kaiser Permanente Division of Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.