The Association of Socio-Economic Factors, and Smoking Behavior With COPD Severity in an Industrial City of Iran
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Abstract
Socioeconomic and lifestyle factors are regarded as important influencing issues regarding a wide range of chronic diseases, including chronic obstructive pulmonary disease. This study aimed to explore the role of such factors as determinants of disease exacerbation among COPD patients. A cross-sectional study was conducted among 150 COPD patients who were referred to an outpatient respiratory care center in Qazvin, Iran, to undertake respiratory function tests from December 2017 to June 2018. Disease severity was determined by the Initiative for Chronic Obstructive Lung Disease (GOLD) index. Odds ratios were applied to find out factors associated with exacerbation. Study findings affirmed that within COPD severity groups, there were significant differences among patients in terms of educational level, smoking status, income, and occupation. Factors associated with severe COPD were found to be smoking (OR 3.6, 2.6-4.2), lower education (OR 1.4, 0.9-2.6), insufficient income (OR 2.3, 0.6-3.1), and unsupportive family (2.7, 1.5-3.6). Due to the obtained evidence about the effect of socioeconomic status on the prognosis of the disease, it is suggested that clinicians should also consider the nonclinical and social aspects associated with the disease in advancing patients' therapeutic procedures and management algorithms.
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11. Curtis LM, Wolf MS, Weiss KB, Grammer LC. The impact of health literacy and socioeconomic status on asthma disparities. J Asthma 2012;49:178-83
12. Schechter MS, Margolis PA. Relationship between socioeconomic status and disease severity in cystic fibrosis. J Pediatr 1998;132:260-4
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15. Adler NE, Boyce T, Chesney MA, Folkman S, Kahn RL, Syme SL. Socioeconomic status and health. The challenge of the gradient. Am Psychol 1994;49:15-24.
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19. Lewis DR, Clegg LX, Johnson NJ. Lung disease mortality in the United States: the National Longitudinal Mortality Study. Int J Tuberc Lung Dis 2009;13:1008-14.
20. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006;28:523-32.
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22. Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD). Global strategy for diagnosis, management and prevention of COPD. Bethesda, MD, USA: GOLD, 2014.
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25. Blanc PD, Iribarren C, Trupin L, Earnest G, Katz PP, Balmes J, et al. Occupational exposures and the risk of COPD: dusty trades revisited. Thorax. 2009;64:6-12.
26. Sahni S, Talwar A, Khanijo S, Talwar A. Socioeconomic status and its relationship to chronic respiratory Disease. Adv Respir Med 2017;85:97-108.
27. Mielck A, Reitmeir P, Wjst M. Severity of childhood asthma by socioeconomic status. Int J Epidemiol 1996;25:388-3.
28. Schikowski T, Sugiri D, Reimann V, Pesch B, Ranft U, Krämer U. Contribution of smoking and air pollution exposure in urban areas to social differences in respiratory health. BMC Public Health 2008;8:179.
29. Britton JR. Effects of social class, sex, and region of residence on age at death from cystic fibrosis. BMJ 1989;298: 483-7
30. Gruer L, Hart CL, Gordon DS, Watt GC. Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study. BMJ 2009;338:b480.
31. Bourke SJ. Interstitial lung disease: progress and problems. Postgrad Med J 2006;82:494-9.
32. Koduri G, Norton S, Young A, Cox N, Davies P, Devlin J, et al. ERAS (Early Rheumatoid Arthritis Study). Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort. Rheumatology (Oxford) 2010;49:1483-9.
33. Greenberg H, Fleischman J, Gouda HE, De La Cruz AE, Lopez R, Mrejen K, et al. Disparities in obstructive sleep apnea and its management between a minority-serving institution and a voluntary hospital. Sleep Breath 2004;8:185-92.
34. Bakker JP, O’Keeffe KM, Neill AM, Campbell AJ. Ethnic disparities in CPAP adherence in New Zealand: effects of socioeconomic status, health literacy and self-efficacy. Sleep 2011;34:1595-603.
35. Roberts ME, Lowndes L, Milne DG, Wong CA. Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis. Intern Med J 2012;42:e129-36.
36. Korpershoek Y, Vervoort S, Nijssen L, Trappenburg J, Schuurmans MJ. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study. Int J Chron Obstruct Pulmon Dis 2016;11:2977-90.
37. Chen Z, Fan VS, Belza B, Pike K, Nguyen HQ. Association between social support and self-care behaviors in adults with chronic obstructive pulmonary disease. Ann Am Thorac Soc 2017;14:1419-27.
2. Roversi S, Corbetta L, Clini E. GOLD 2017 recommendations for COPD patients: toward a more personalized approach. COPD Res Pract 2017;3:1-6.
3. Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet 2012;379:1341-51.
4. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1545-602.
5. Tazesh B, Shaabani A, Fazlollahi MR, Entezari A, Dashti R, Pourpak Z, et al. Prevalence of asthma symptoms and smoking behavior among 20-44 years old adults in Tehran: A telephone survey. Health 2013;5:469-74.
6. Sharifi H, Masjedi MR, Emami H, Ghanei M, Eslaminejad A, Radmand G, et al. Burden of obstructive lung disease study in Tehran: Prevalence and risk factors of chronic obstructive pulmonary disease. Lung India 2015;32:572-7.
7. Sharifi H, Masjedi MR, Emami H, Ghanei M, Buist S. Burden of obstructive lung disease study in tehran: research design and lung spirometry protocol. Int J Prev Med 2014;5:1439-45.
8. Sharifi H, Masjedi MR, Emami H, Ghanei M, Eslaminejad A, Radmand G, et al. Interim Report from Burden of Obstructive Lung Disease (BOLD Study) in Tehran: Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease. Tanaffos 2014;13:6-13.
9. Pirozzi C, Scholand MB. Smoking cessation and environmental hygiene. Med Clin North Am 2012;96:849-67.
10. Gershon AS, Dolmage TE, Stephenson A, Jackson B. Chronic obstructive pulmonary disease and socioeconomic status: a systematic review. COPD 2012;9:216-26.
11. Curtis LM, Wolf MS, Weiss KB, Grammer LC. The impact of health literacy and socioeconomic status on asthma disparities. J Asthma 2012;49:178-83
12. Schechter MS, Margolis PA. Relationship between socioeconomic status and disease severity in cystic fibrosis. J Pediatr 1998;132:260-4
13. Krieger N, Krieger N, Krieger N. A glossary for social epidemiology. J Epidemiol Community Health 2001;55:693-700,
14. Kington RS, Smith JP. Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. Am J Public Health 1997;87:805-10.
15. Adler NE, Boyce T, Chesney MA, Folkman S, Kahn RL, Syme SL. Socioeconomic status and health. The challenge of the gradient. Am Psychol 1994;49:15-24.
16. Pandolfi P, Zanasi A, Musti MA, Stivanello E, Pisani L, Angelini S, et al. Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients. PLoS ONE 2015;10:e0135116.
17. Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci 2012;1248:107-23.
18. Broms U, Silventoinen K, Lahelma E, Koskenvuo M, Kaprio J. Smoking cessation by socioeconomic status and marital status: the contribution of smoking behavior and family background. Nicotine Tob Res 2004;6:447-55.
19. Lewis DR, Clegg LX, Johnson NJ. Lung disease mortality in the United States: the National Longitudinal Mortality Study. Int J Tuberc Lung Dis 2009;13:1008-14.
20. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006;28:523-32.
21. Chan-Yeung M, Ho AS, Cheung AH, Liu RW, Yee WK, Sin KM, et al. Determinants of chronic obstructive pulmonary disease in Chinese patients in Hong Kong. Int J Tuberc Lung Dis 2007;11:502-507.
22. Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD). Global strategy for diagnosis, management and prevention of COPD. Bethesda, MD, USA: GOLD, 2014.
23. Afessa B, Morales IJ, Scanlon PD, Peters SG. Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care med 2002;30:1610-5.
24. Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, et al. Socioeconomic status, race, and COPD health outcomes J Epidemiol Community Health 2011;65:26-34.
25. Blanc PD, Iribarren C, Trupin L, Earnest G, Katz PP, Balmes J, et al. Occupational exposures and the risk of COPD: dusty trades revisited. Thorax. 2009;64:6-12.
26. Sahni S, Talwar A, Khanijo S, Talwar A. Socioeconomic status and its relationship to chronic respiratory Disease. Adv Respir Med 2017;85:97-108.
27. Mielck A, Reitmeir P, Wjst M. Severity of childhood asthma by socioeconomic status. Int J Epidemiol 1996;25:388-3.
28. Schikowski T, Sugiri D, Reimann V, Pesch B, Ranft U, Krämer U. Contribution of smoking and air pollution exposure in urban areas to social differences in respiratory health. BMC Public Health 2008;8:179.
29. Britton JR. Effects of social class, sex, and region of residence on age at death from cystic fibrosis. BMJ 1989;298: 483-7
30. Gruer L, Hart CL, Gordon DS, Watt GC. Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study. BMJ 2009;338:b480.
31. Bourke SJ. Interstitial lung disease: progress and problems. Postgrad Med J 2006;82:494-9.
32. Koduri G, Norton S, Young A, Cox N, Davies P, Devlin J, et al. ERAS (Early Rheumatoid Arthritis Study). Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort. Rheumatology (Oxford) 2010;49:1483-9.
33. Greenberg H, Fleischman J, Gouda HE, De La Cruz AE, Lopez R, Mrejen K, et al. Disparities in obstructive sleep apnea and its management between a minority-serving institution and a voluntary hospital. Sleep Breath 2004;8:185-92.
34. Bakker JP, O’Keeffe KM, Neill AM, Campbell AJ. Ethnic disparities in CPAP adherence in New Zealand: effects of socioeconomic status, health literacy and self-efficacy. Sleep 2011;34:1595-603.
35. Roberts ME, Lowndes L, Milne DG, Wong CA. Socioeconomic deprivation, readmissions, mortality and acute exacerbations of bronchiectasis. Intern Med J 2012;42:e129-36.
36. Korpershoek Y, Vervoort S, Nijssen L, Trappenburg J, Schuurmans MJ. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study. Int J Chron Obstruct Pulmon Dis 2016;11:2977-90.
37. Chen Z, Fan VS, Belza B, Pike K, Nguyen HQ. Association between social support and self-care behaviors in adults with chronic obstructive pulmonary disease. Ann Am Thorac Soc 2017;14:1419-27.
| Files | ||
| Issue | Vol 59, No 7 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v59i7.7026 | |
| Keywords | ||
| Socioeconomic status Smoking Chronic obstructive pulmonary disease Severity Exacerbation | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zohal M, Rafiei S, Esmailzadehha N, Jamshidi S, Rastgoo N. The Association of Socio-Economic Factors, and Smoking Behavior With COPD Severity in an Industrial City of Iran. Acta Med Iran. 2021;59(7):447-453.
