High Prevalence of COPD Found Among African-American Women Who Never Smoked

Women who have never smoked are still vulnerable to develop chronic obstructive pulmonary disease (COPD). African-American women are especially susceptible to the disease, researchers at the University of Toronto found.

The results of the study, “COPD in a Population-Based Sample of Never-Smokers: Interactions among Sex, Gender, and Race,” were published in the International Journal of Chronic Diseases.

COPD is the third-leading cause of death in the United States and a main cause of disability, with smoking being considered the largest, single-risk factor for COPD. Because smoking rates are decreasing in the U.S., there is an increased need to identify, among never-smokers, groups that are at higher risk for developing COPD.

Researchers performed an observational epidemiological study to examine sex/gender and racial differences in the prevalence of COPD among never-smokers. The researchers retrieved data from the 2012 Center for Disease Control’s Behavioral Risk Factor Surveillance System for 129,535 non-Hispanic whites and blacks, 50 years and older, who had never smoked. Overall, 8,674 African-American women, 2,708 African-American men, 80,317 white women, and 37,836 white men, were included in the analyses.

Researchers found that women had a significantly higher likelihood of developing COPD than men. Specifically, the data showed that African-American women have the highest prevalence of COPD (7.0%), followed by white women (5.2%), white men (2.9%), and African-American men (2.4%).

“Some of women’s greater vulnerability to COPD may be due to physiological differences. When we took into account height (a proxy for lung size), the odds of COPD among women compared to men were less elevated. However, we still found women had approximately 50% higher odds of COPD compared to white men, even when we adjusted for height, education, income, and healthcare access” professor Esme Fuller-Thomson, PhD, lead study author, said in a press release. “Hormones may also play a role. In addition, women are more likely to have been exposed to second-hand smoke from spouses who smoke,” said Fuller-Thomson, who is Sandra Rotman Endowed Chair and Director of the Institute for Life Course & Aging at the University of Toronto’s Factor-Inwentash Faculty of Social Work.

When they adjusted the data for socioeconomic position, black and white women were found to have comparably higher odds of COPD than white men, while black men were found to have significantly lower odds for COPD.

“African-American women had, by far, the highest prevalence of COPD among older adults who had never smoked. We found that after adjusting for income and education levels, the odds of COPD among African-American women compared to white men declined by more than half. We cannot determine causality with this data set, but poverty is associated with increased exposure to toxins, such as second-hand smoke in workplaces and air pollution in inner-city environments. Future research needs to investigate if these factors play a role in the greater vulnerability of African-American women,” said study co-author Rachel Chisholm.

“Primary care physicians and other health professionals should consider screening all their older patients for COPD, including those who have never smoked. Women, particularly African-American women, have an unexpectedly high prevalence of COPD. Earlier detection of COPD has been found to improve patient outcomes in both the short- and long-term and is therefore an important clinical goal,” added Fuller-Thomson.