Low-income people with COPD more likely to die of disease than wealthier counterparts

The number of people living with chronic obstructive pulmonary disease (COPD), also known as emphysema or chronic bronchitis, increased nearly 90 per cent in 15 years but mortality from the disease has declined over the same period, according to new research done at the Institute for Clinical Evaluative Sciences (ICES). However, that decline is much less pronounced in people of the lowest socioeconomic status in Ontario.

“We need to stop looking at disparity as an economic issue, it also applies to peoples’ health. Overall people with COPD are living longer, but this good news is not being experienced equally by all. People of low income are also living longer, but not to the same extent as their wealthier counterparts,” says Dr. Andrea Gershon, lead author, ICES Scientist and Respirologist and Scientist at Sunnybrook Health Sciences Centre.

COPD is a chronic, progressive respiratory disease that is most often due to smoking but can also be due to exposure to second-hand smoke, pollution and possibly asthma. Once someone has COPD, it is incurable but symptoms and other health outcomes can be improved with treatment. It is the third leading cause of death and a leading cause of hospitalizations worldwide.

The study published in the Annals of the American Thoracic Society found:

• An 88.8 per cent increase in the people with COPD living in Ontario from 1996 to 2011/12.
• All-cause mortality of the COPD population decreased from 5.7 per cent in 1996 to 3.7 per cent in 2011/12. 
• Mortality in all quintiles declined over time, however, the decline was less pronounced in the lowest compared to the highest income quintile (30 per cent compared to 38 per cent).
• This trend was most evident in younger women and older men.

“Compared to higher socioeconomic status people, people of lower socioeconomic status are sicker than they were 15 years ago. Our study shows an increase of 28 per cent in the mortality rate difference between the lowest and highest income quintiles,” adds Gershon.

The researchers add that inequalities in health are a central challenge for public health.  Eliminating such disparity could potentially reduce disease burden, need for health services, and costs more than newly developed medications.

The study “Trends in socioeconomic status related differences in mortality among people with chronic obstructive pulmonary disease (COPD),” was published in the Annals of the American Thoracic Society.

Authors: Andrea S. Gershon, Jeremiah Hwee, J. Charles Victor, Andrew S Wilton and Teresa To.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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