Chronic obstructive pulmonary disease and subsequent overall and lung cancer mortality in low-income adults.

Aldrich MC, Munro HM, Mumma M, Grogan EL, Massion PP, Blackwell TS, Blot WJ. Chronic obstructive pulmonary disease and subsequent overall and lung cancer mortality in low-income adults. PLoS ONE. 2015 Mar 26; 10(3):e0121805.

Related HSR&D Project(s)

• CDP 12-186 – Decreasing Unnecessary Invasive Lung Cancer Diagnostic Procedures (CDA 10-024)
• CDA 10-024 – Decreasing Unnecessary Invasive Lung Cancer Diagnostic Procedures

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Abstract:

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a known risk factor for lung cancer and a leading cause of mortality in the U.S., but its impact may not be fully appreciated, especially among low-income populations in the southeast where COPD prevalence and lung cancer incidence are elevated. METHODS: We conducted a prospective study among 26,927 low-income adults age 40-79 in the Southern Community Cohort Study who had a Center for Medicare and Medicaid Services (CMS) encounter prior to enrollment and were followed for a median of over 6 years. Using a validated algorithm for assessing COPD from CMS claims data, we estimated COPD prevalence and potential misreporting. From Cox proportional hazard models, we computed overall and lung cancer-specific mortality according to COPD status. RESULTS: The overall prevalence of CMS-diagnosed COPD was 16%, but was twice as high among whites as blacks. Only 35% of these individuals, however, self-reported having COPD, with underreporting significantly greater for blacks than whites. Smoking-adjusted all-cause mortality was increased by 1.7-fold and lung cancer mortality by 2.3-fold among those with a CMS COPD diagnosis, with similar patterns in blacks and whites, but no excess was found among those self-reporting COPD and without CMS confirmation. CONCLUSION: The prevalence of COPD in this low-income population may be greater than previously recognized and misreporting is common. COPD is associated with elevated lung cancer mortality, even among those not self-reporting the condition.