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Original Research: OBSTRUCTIVE LUNG DISEASES |

Racial Differences in Quality of Life in Patients With COPDRacial Differences in Quality of Life in COPD

MeiLan K. Han, MD; Douglas Curran-Everett, PhD; Mark T. Dransfield, MD; Gerard J. Criner, MD, FCCP; Lening Zhang, PhD; James R. Murphy, PhD; Nadia N. Hansel, MD, MPH; Dawn L. DeMeo, MD, MPH; Nicola A. Hanania, MD, FCCP; Elizabeth A. Regan, MD, PhD; Barry J. Make, MD, FCCP; Fernando J. Martinez, MD, FCCP; Gloria E. Westney, MD; Marilyn G. Foreman, MD, FCCP,; the COPDGene Investigators
Author and Funding Information

From the University of Michigan Health System (Drs Han and Martinez), Ann Arbor, MI; National Jewish Health (Drs Curran-Everett, Zhang, Murphy, Regan, and Make) and University of Colorado Denver (Dr Curran-Everett), Denver, CO; University of Alabama-Birmingham (Dr Dransfield), Birmingham, AL; Temple University School of Medicine (Dr Criner), Philadelphia, PA; Johns Hopkins University (Dr Hansel), Baltimore, MD; Brigham and Women’s Hospital and Harvard Medical School (Dr DeMeo), Boston, MA; Baylor College of Medicine (Dr Hanania), Houston, TX; and Morehouse School of Medicine (Drs Westney and Foreman), Atlanta, GA.

Correspondence to: MeiLan K. Han, MD, University of Michigan Health System, 3916 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109; e-mail: mrking@umich.edu


Funding/Support: The project was supported by the National Heart, Lung, and Blood Institute [award numbers U01HL089897 and U01HL089856]. The COPDGene project also is supported by the COPD Foundation through contributions made to an industry advisory board comprising AstraZeneca, Boehringer Ingelheim GmbH, Novartis Pharmaceuticals Corporation, and Sepracor Inc. Dr Han is supported by funding from the National Heart, Lung and Blood Institute [Grant K23 HL093351].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1169-1176. doi:10.1378/chest.10-2869
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Background:  Although COPD is associated with significant health-related quality-of-life (HRQL) impairment, factors influencing HRQL in patients with COPD are not well understood, particularly in African Americans. We hypothesized that HRQL in COPD differs by race and sought to identify factors associated with those differences.

Methods:  We analyzed 224 African American and 1,049 Caucasian subjects with COPD enrolled in the COPDGene (Genetic Epidemiology of COPD) Study whose conditions were classified as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to IV. HRQL and symptoms were compared using the St. George Respiratory Questionnaire (SGRQ) and the modified Medical Research Council Dyspnea (MMRC) scale. We constructed a mixed-effects linear regression model for SGRQ score.

Results:  African Americans were younger and reported fewer pack-years of smoking, more current smoking, and less attained education than Caucasians; MMRC scores were higher (P = .02) as were SGRQ scores (mean score difference, 8.4; P < .001). In a general linear model of SGRQ total score after adjusting for factors such as age, sex, and pack-years of smoking, SGRQ total score was similar for African Americans and Caucasians who reported no COPD exacerbations in the prior year. However, for subjects with exacerbations, SGRQ total score was increased to a greater relative extent for African Americans than for Caucasians (1.89 points for each exacerbation, P = .006). For hospitalized exacerbations, the effect on SGRQ total score also was greater for African Americans (4.19 points, P = .04). Furthermore, a larger percentage of African Americans reported having had at least one exacerbation that required hospitalization in the prior year (32% vs 16%, P < .001).

Conclusion:  In analyses that account for other variables that affect quality of life, HRQL is similar for African Americans and Caucasians with COPD without exacerbations but worse for African Americans who experience exacerbations, particularly hospitalized exacerbations.

Trial registry:  ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov


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