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Trends in socioeconomic status related differences in mortality among people with chronic obstructive pulmonary disease


Rationale — Previous studies have demonstrated that people of higher socioeconomic status have better chronic obstructive pulmonary disease (COPD) health outcomes than those of lower socioeconomic status. Mortality of people with COPD has decreased over the last decade; however, it is not known if all have benefitted equally.

Objective — The objective of the current study was to examine the impact of socioeconomic status on mortality trends of individuals with COPD.

Methods — The authors conducted a population-based study using health administrative data from Ontario, Canada, between 1996/7 to 2011/12. Individuals with COPD were identified using a previously validated case definition. Socioeconomic status was determined using individuals’ average household income of their neighborhood as per the Canadian Census. Trends in standardized COPD mortality rates among different socioeconomic status quintiles were observed over time.

Measurements and Main Results — Overall, age- and sex-standardized mortality of people with COPD decreased from 5.7% (95% CI: 5.5% to 5.8%) in 1996/7 to 3.7% (95% CI: 3.6% to 3.8%) in 2011/12, representing a 35% relative decrease. The mortality difference between the lowest and highest income quintiles increased from 67 per 10,000 individuals in 1996/7 to 86 per 10,000 individuals in 2011/12, representing a 28% relative increase (p<0.001).

Conclusions — Mortality in people with COPD has decreased faster in people the highest compared to the lowest socioeconomic status causing increased disparity between rich and poor. Further study and strategies are needed to explore and address factors responsible for increasing disparity in the COPD population.



Gershon AS, Hwee J, Victor JC, Wilton AS, To T. Ann Am Thorac Soc. 2014; 11(8):1195-202. Epub 2014 Aug 28.

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Contributing ICES Scientists


Dr. Andrea Gershon discusses her study which found that low income people with COPD are more likely to die of the disease than wealthier counterparts.

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