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Original Research: COPD |

Socioeconomic Characteristics Are Major Contributors to Ethnic Differences in Health Status in Obstructive Lung DiseaseQuality of Life in Mexican Americans With COPD: An Analysis of the National Health and Nutrition Examination Survey 2007-2010

Carlos H. Martinez, MD, MPH; David M. Mannino, MD, FCCP; Jeffrey L. Curtis, MD; MeiLan K. Han, MD; Alejandro A. Diaz, MD, MPH
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Martinez, Curtis, and Han), University of Michigan Health System, Ann Arbor, MI; Division of Pulmonary, Critical Care and Sleep Medicine (Dr Mannino), University of Kentucky College of Medicine, Lexington, KY; Department of Epidemiology, Preventive Medicine and Environmental Health (Dr Mannino), University of Kentucky College of Public Health, Lexington, KY; VA Ann Arbor Healthcare System (Dr Curtis), Ann Arbor, MI; and Division of Pulmonary and Critical Care Medicine (Dr Diaz), Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

CORRESPONDENCE TO: Carlos H. Martinez, MD, MPH, Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 3916 Taubman Center, Box 0360, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5360; e-mail: carlosma@umich.edu


Part of this article has been presented in abstract form at the 2014 International Conference of the American Thoracic Society, May 16-21, 2014, San Diego, CA.

FUNDING/SUPPORT: Dr Martinez is supported by funding from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI) [Grant T32 HL007749-20]. Dr Han is supported by funding from NIH NHLBI [Grant K23 HL093351]. Dr Curtis is supported by funding from the Clinical Research and Development Service, Department of Veterans Affairs, and the US Public Health Service [Grant U01 HL098961]. Dr Diaz is supported by funding from NIH NHLBI [Grant K01 HL118714].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):151-158. doi:10.1378/chest.14-1814
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BACKGROUND:  Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors.

METHODS:  We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV1/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS.

RESULTS:  Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites.

CONCLUSIONS:  Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.

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