Advanced Emphysema in African-American and White Patients: Discussion

Socioeconomic status is another aspect that may have a significant confounding effect on the prevalence of emphysema. This aspect is difficult to control for because it entrains access to health care, level of education, environmental exposure, and possibly respiratory infections. Race and socioeconomic status are closely entwined, and patients with lower levels of income often receive substandard care due to lack of insurance, delay in seeking health care, reliance on hospital clinics and emergency departments, and less referrals to specialists. It is also possible that African Americans with emphysema are underdiagnosed because they are perceived to be “protected” and their symptoms are attributed to other illnesses, including asthma and heart disease. In a national survey, the prevalence of COPD (by history) was found to increase with age in white subjects but not in African Americans, although the age-specific percentage of African Americans having obstructive lung disease by spirometry (FEV1/FVC ratio < 70 and FEV1 < 80% of predicted) was actually similar or higher compared to whites. Although no studies are available on racial bias in diagnosing COPD, this tendency has been observed in women, a population that was thought to be less susceptible to injury from smoking. The aforementioned observations suggest that COPD/ emphysema may be underdiagnosed in African Americans. More info
Are African Americans less susceptible to pulmonary damage from cigarette smoking than whites, and do they have a different emphysema phenotype despite comparable physiology and impairment? Although prevalence data might suggest a racial discrepancy in susceptibility, this study and a previous report from our clinic indicate that there is a group of African-American patients who are as susceptible to emphysema, if not more so, than white patients possibly because of their younger age and lower smoking burden at presentation.  Moreover, the meta-analysis performed by Vollmer and col-leagues in gender/race strata of eight large population-based studies failed to demonstrate a difference in smoking-related decrements in lung function between African-Americans and white patients (excess FEV1 decline attributed to smoking > 10 cigarettes per day, — 7 ± 1.2 mL/yr vs — 10 ± 1.0 mL/yr; p > 0.05) arguing against major differences in susceptibility. Nevertheless, since African Americans may present earlier in life with severe emphysema, one may postulate that the disease burden or phenotypic expression of emphysema are different between the two races.

This entry was posted in Emphysema and tagged African American, copd, CT, emphysema, epidemiology, pulmonary function testing, radiography.