Defining and targeting health disparities in chronic obstructive pulmonary disease

Abstract

The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1) better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2) educating the public and those involved in health care provision about the disease, 3) improving access to cost-effective and affordable health care, and 4) markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations.

Keywords: COPD; health disparities; international; interventions; management; prevention; socioeconomic status.

Figure 1

All-cause mortality rate by socioeconomic status among COPD patients in Canada from 1996/1997 to 2011/2012. Note: Reprinted with permission of the American Thoracic Society. Copyright © 2016 American Thoracic Society. Gershon AS, Hwee J, Victor JC, Wilton AS, To T. 2014. Trends in socioeconomic status-related differences in mortality among people with chronic obstructive pulmonary disease. Ann Am Thorac Soc. 11:1195–1202. The Annals of the American Thoracic Society is an official journal of the American Thoracic Society. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2

World Health Organization drug therapy guidelines for managing acute exacerbations of COPD and stable management in resource limited settings. Note: Reprinted from World Health Organization. Prevention and control of non-communicable diseases: guidelines for primary health care in low-resource settings. Copyright 2012. Abbreviations: ADRs, adverse drug reactions; AECOPD, acute exacerbation of COPD; COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus; ICS, inhaled corticosteroid; IV, intravenous.