Original Article
Role of Socioeconomic Factors on Physical and Mental Distress Reported by Alabama Adults with COPD
Abstract
Objectives: Educational attainment, income, and race play significant roles in managing and treating patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the impact of these socioeconomic factors and others on the physical and mental distress reported by patients with COPD living in Alabama.Methods: A cross-sectional analysis was completed of Alabama Behavioral Risk Factor Surveillance System 2015–2019 data collected from 4123 respondents who reported that a health professional told them they had COPD, chronic bronchitis, or emphysema. Univariate analyses examined descriptive differences in physical and mental distress among racial groups. Multivariable logistic regression models were used to assess physical and mental distress as a function of race and demographic variables (age, sex, employment status, household income, education level), controlling for dichotomous healthcare access variables (enrollment in a health insurance plan, having a usual source of care, routine check-up in the past 2 years).
Results: Most Alabama adults with COPD from 2015 to 2019 were female (64%) and older than 45 years (88%). Annual incomes were low, with >40% of respondents (43.84%) earning <$20,000/year; adults making between $35,000 and $49,999 were less likely (odds ratio 0.60, 95% confidence interval 0.38–0.96) to experience mental distress. Younger Alabama adults with COPD (25–64 years) were approximately two times more likely than respondents ages 65 and older to report mental distress. African Americans were less likely to report physical distress as compared with Whites (odds ratio 0.61, 95% confidence interval 0.44–0.83). Alabama adults who could not work were more likely than those with COPD who were employed/self-employed, out of work, retired, or identified as homemakers to report physical distress.
Conclusions: Public health and healthcare practitioners across Alabama should use these analyses to direct more targeted, high-yield interventions that will address existing health disparities among state residents living with COPD.
Posted in: Mental Health44
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References
1. American Lung Association. Learn about COPD. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd. Updated March 5, 2021. Accessed on August 6, 2021.
2. Khakban A, Sin DD, FitzGerald JM, et al. The projected epidemic of COPD hospitalizations over the next 15 years: a population based perspective. Am J Respir Crit Care Med. 2016. https://www.atsjournals.org/doi/full/10.1164/rccm.201606-1162PP#.V_Kk_vkrK00. Accessed April 23, 2022.
3. Criner R, Han M. COPD care in the 21st century: a public health priority. Respir Care 2018;63:591–600.
4. Au DH, Feemster LC. Chronic obstructive pulmonary disease. Health disparity and inequity. Ann Am Thorac Soc 2014;11:1250–1251.
5. Mannino DM, Homa DM, Akinbami LJ, et al. Chronic obstructive pulmonary disease surveillance—United States, 1971–2000. MMWR Surveill Summ 2002; 51:1–16.
6. Sullivan J, Pravosud V, Mannino DM, et al. National and state estimates of COPD morbidity and mortality—United States, 2014–2015. Chronic Obstr Pulm Dis 2018;5:324–333.
7. COPD Foundation. COPD in the United States: How is your state doing? https://www.copdfoundation.org/Portals/0/StateAssessmentCards/SAC_AL_2018.pdf. Published 2018. Accessed August 6, 2021.
8. Alabama Public Health. Black Belt Action Commission. Selected Health Status Indicators. https://www.alabamapublichealth.gov/ruralhealth/assets/BBACData.pdf. Published October 2007. Accessed August 6, 2021.
9. Pleasants R, Riley I, Mannino D. Defining and targeting health disparities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016;11:2475–2496.
10. Ejike CO, Dransfield MT, Hansel NN, et al. Chronic obstructive pulmonary disease in America’s black population. Am J Resp Crit Care Med 2019;200: 423–430.
11. Eisner MD, Blanc PD, Omachi TA, et al. Socioeconomic status, race and COPD health outcomes. J Epidemiol Commun Health 2011;65:26–34.
12. US Institute of Medicine Committee on a National Surveillance System for Cardiovascular and Select Chronic Diseases. Health disparities. In: A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases. Washington, DC: The National Academies Press; 2011.
13. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Updated October 11, 2018. https://www.cdc.gov/brfss/data_documentation/index.htm. Accessed September 21, 2020.
14. Centers for Disease Control and Prevention. Measuring healthy days. Population assessment of health-related quality of life. https://www.cdc.gov/hrqol/pdfs/mhd. pdf. Published November 2000. Accessed September 21, 2020.
15. Stellefson M, Wang MQ, Balanay JA, et al. Health risk disparities among employed adults with COPD living in central Appalachian US states. Am J Health Educ 2020;51:265–277.
16. Stellefson M, Paige SR, Barry AE, et al. Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data. Int J Chron Obstruct Pulmon Dis 2019;14:809–822.
17. Jiang Y, Zack MM. A latent class modeling approach to evaluate behavioral risk factors and health-related quality of life. Prev Chronic Dis 2011;8:A137.
18. Li C, Ford ES, Mokdad AH, et al. Clustering of cardiovascular disease risk factors and health-related quality of life among US adults. Value Health 2008;11:689–699.
19. Okoro CA, Brewer RD, Naimi TS, et al. Binge drinking and health-related quality of life: do popular perceptions match reality? Am J Prev Med 2004;26:230–233.
20. Jarad N. Chronic obstructive pulmonary disease (COPD) and old age? Chron Respir Dis 2011;8:143–151.
21. Tzitzikos G, Kotrotsiou E, Bonotis K, et al. Assessing hostility in patients with chronic obstructive pulmonary disease (COPD). Psychol Health Med 2019;24:605–619.
22. Rai KK, Jordan RE, Siebert WS, et al. Birmingham COPD cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD. Int J Chron Obstruct Pulmon Dis 2017;12:233–242.
23. Gilkes A, Ashworth M, Schofield P, et al. Does COPD risk vary by ethnicity? A retrospective cross-sectional study. Int J Chron Obstruct Pulmon Dis 2016;11:739–746.
24. Ejike CO, Woo H, Galiatsatos P, et al. Contribution of individual and neighborhood factors to racial disparities in respiratory outcomes. Am J Respir Crit Care Med 2021;203:987–997.
25. Gillum RF. Chronic obstructive pulmonary disease in blacks and whites: pulmonary function norms and risk factors. J Natl Med Assoc 1991;83:393–401.
26. Holt JB, Zhang X, Presley-Cantrell L, et al. Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States. Int J Chron Obstruct Pulmon Dis 2011; 6:321–328.
27. Stein AD, Courval JM, Lederman RI, et al. Reproducibility of responses to telephone interviews: demographic predictors of discordance in risk factor status. Am J Epidemiol 1995;141:1097–1105.
