Socioeconomic status, lung function and admission to hospital for COPD: results from the Copenhagen City Heart Study

Abstract

This study analysed the effect of education and income on development of chronic obstructive pulmonary disease (COPD) assessing lung function and hospital admission.The study population consisted of 14,223 subjects, aged 20±90 yrs, randomly sampled from the population of Copenhagen in 1976. Association between socioeconomic factors and forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) at study entry was analysed by linear regression. The relation between socioeconomic factors and risk of admission to hospital for COPD from study entry until 1993 was assessed by register linkage.Education and income were independently associated with FEV1 and FVC. The age-and height-adjusted difference in FEV1 (mean SEM) between the highest and lowest level of education and income was 259 31 mL in females and 400 39 mL in males. After additional adjustment for quantity and duration of smoking and inhalation, the difference was 220 31 mL and 363 39 mL in females and males, respectively. Results for FVC were of the same magnitude. Using a socioeconomic index which combined information on education and household income the association with lung function did not differ by age. A total of 219 females and 265 males were admitted to hospital for COPD during follow-up. Education and income were significantly associated with admission to hospital. After detailed adjustment for smoking the relative risks (95% confidence intervals) for medium and high versus low socioeconomic index in females were 0.74 (0.55±1.02) and 0.27 (0.10±0.73), respectively. Corresponding relative risks in males were 0.47 (0.36±0.63) and 0.35 (0.17±0.70).The results indicate that socioeconomic factors operating from early in life affect the adult risk of developing chronic obstructive pulmonary disease independently of smoking in both females and males.

Socio-economic status is related to incidence of asthma and respiratory symptoms in adults

“…The divergent findings may be a result of differences in study design, varying definitions of socio-economic status, the age distributions of the studied samples, differences in exposures, occupational and otherwise, and geographical aspects. Generally, studies in Nordic countries have found more symptoms or asthma [5,23], lower lung function [24] or a greater prevalence of chronic obstructive pulmonary disease [25,26] in lower SECs. The present results confirm those of previously performed cohort studies, one of Nordic adults [9] and the other of US adolescents [10].…”

Prevalence of COPD in Primary Care Clinics: Correlation with Non-Respiratory Diseases

“…In particular, the patients with liver diseases had a significantly higher prevalence of COPD when the odds ratio was adjusted by the amount of smoking and age. (18,19), lung growth (20), gender (21,22), socioeconomic status (23) and nutrition (24). Furthermore, recently, it has been reported that systemic inflammation could be involved in the pathogenesis of COPD (5)(6)(7), and that COPD patients are at increased risk for several comorbidities including myocardial infarction, osteoporosis, depression and diabetes (1).…”

Social determinants of intra-urban differentials of admissions by respiratory diseases in Salvador (BA), Brazil

“…The importance of this group of diseases in the world in the coming years is evident with the prediction that, in 2030, chronic obstructive pulmonary diseases and respiratory infections are among the five leading causes of death 4 . The risk of hospitalization or greater severity of these diseases is higher in population groups that have the lowest socioeconomic indicators, such as low income and education, both for chronic respiratory diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD) 5,6 , and for infectious diseases, such as pneumonia 7 . Thus, social determinants are important in determining both the distribution of infectious diseases and chronic noncommunicable diseases, although the action mechanisms and consequences may differ 8 .…”