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Correspondence |

Racial Differences Influence Health-Related Quality-of-Life MeasurementsRacial Difference and Quality of Life FREE TO VIEW

Li-Cher Loh, MD
Author and Funding Information

From Lung Research, Department of Medicine, Penang Medical College.

Correspondence to: Li-Cher Loh, MD, FCCP, Lung Research, Department of Medicine, Penang Medical College, 4 Jalan Sepoy Lines, Penang 10450 Malaysia; e-mail: richard_loh@pmc.edu.my


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2012 American College of Chest Physicians


Chest. 2012;141(2):570-571. doi:10.1378/chest.11-2409
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To the Editor:

I read with interest the article by Han et al1 in a recent issue of CHEST (November 2011) that shows African Americans with a prior history of COPD exacerbations reported worse health-related quality of life (HRQL) than their Caucasian counterparts despite having comparable lung functions. The data analyzed are huge and multi-centered in origin from the United States. In their statistical regression model, this racial factor remains independently associated with worse HRQL, along with several other variables such as dyspnea, age, smoking duration, and education level.

In a much smaller sample of local patients with persistent moderate-to-severe asthmatics, my colleagues and I have previously published that patients of Indian ethnicity, compared with those of Malays or Chinese ethnicity, reported worse HRQL based on the St. George Respiratory Questionnaire. These patients remained independently associated with lower HRQL after adjustment for age, sex, asthma duration, and inhaled corticosteroid dose.2 In our model of multiple regression using variables identified from factor analysis, education level stood together with Indian ethnicity as being independent associates. Although they studied different airway diseases, both these studies look at the influence of racial difference on HRQL of patients with chronic persistent airway diseases.

Han et al1 rightly discussed this from the perspective of disease exacerbations, and considered factors among African Americans like “experience” of breathlessness, education level, and socio-economic status with implications on health insurance as plausible explanations for worse HRQL. The obvious implication of this is how best to prevent and manage the exacerbations of African Americans. Here, disease exacerbations are perceived as the link to understanding why a particular race of people reports poorer HRQL.

Another important perspective when interpreting racial differences in HRQL findings is to consider HRQL as a measuring tool that lacks the sensitivity to discern influence of racial and cultural differences. Many such tools are developed primarily in homogenous, well-educated patient populations that may not be universally interpretable when applied across different cultures and ethnicity.3 Findings like ours and those of Han et al lend support to such a notion, especially since different ethnic groups can report differing HRQL despite being comparable in lung function and disease severity. The implication from this is whether we can reliably interpret measurements of HRQL across different cultures and ethnicity, for example, in worldwide multi-center studies4 and draw meaningful conclusions from them. Perhaps we should be mindful of these implications when interpreting HRQL measurements and appreciate that the racial influence exists and can be potent.5,6

Han MK, Curran-Everett D, Dransfield MT, et al; and the COPD Gene Investigators and the COPD Gene Investigators Racial differences in quality of life in patients with COPD. Chest. 2011;1405:1169-1176 [PubMed] [CrossRef]
 
Loh LC, Teh PN, Seth KD, Raman S, Vijayasingham P, Thayaparan T. Ethnicity as a determinant of asthma-related quality of life in a multiracial country. Asia Pac J Public Health. 2006;181:49-55 [PubMed]
 
Kuyken W, Orley J, Hudelson P, Sartorius N. Quality of life assessment across cultures. Int J Ment Health. 1994;23:5-27
 
Ståhl E, Postma DS, Juniper EF, Svensson K, Mear I, Löfdahl CG. Health-related quality of life in asthma studies. Can we combine data from different countries? Pulm Pharmacol Ther. 2003;161:53-59 [PubMed]
 
Ng TP, Lim LC, Jin A, Shinfuku N. Ethnic differences in quality of life in adolescents among Chinese, Malay and Indians in Singapore. Qual Life Res. 2005;147:1755-1768 [PubMed]
 
Olson LM, Lara M, Pat Frintner M. Measuring health status and quality of life for US children: relationship to race, ethnicity, and income status. Ambul Pediatr. 2004;4suppl 4:377-386 [PubMed]
 

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References

Han MK, Curran-Everett D, Dransfield MT, et al; and the COPD Gene Investigators and the COPD Gene Investigators Racial differences in quality of life in patients with COPD. Chest. 2011;1405:1169-1176 [PubMed] [CrossRef]
 
Loh LC, Teh PN, Seth KD, Raman S, Vijayasingham P, Thayaparan T. Ethnicity as a determinant of asthma-related quality of life in a multiracial country. Asia Pac J Public Health. 2006;181:49-55 [PubMed]
 
Kuyken W, Orley J, Hudelson P, Sartorius N. Quality of life assessment across cultures. Int J Ment Health. 1994;23:5-27
 
Ståhl E, Postma DS, Juniper EF, Svensson K, Mear I, Löfdahl CG. Health-related quality of life in asthma studies. Can we combine data from different countries? Pulm Pharmacol Ther. 2003;161:53-59 [PubMed]
 
Ng TP, Lim LC, Jin A, Shinfuku N. Ethnic differences in quality of life in adolescents among Chinese, Malay and Indians in Singapore. Qual Life Res. 2005;147:1755-1768 [PubMed]
 
Olson LM, Lara M, Pat Frintner M. Measuring health status and quality of life for US children: relationship to race, ethnicity, and income status. Ambul Pediatr. 2004;4suppl 4:377-386 [PubMed]
 
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