All-cause mortality rates in COPD similar for Black, white individuals
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In a cohort of patients with COPD, researchers observed no significant differences in all-cause mortality between Black and white individuals, although there were differences regarding comorbidity-related mortality, study results showed.
“Black women in our study had a high burden of cardiovascular risk factors compared with other race-sex groups with COPD, and a higher risk of cardiovascular disease-related death compared with white women,” Jamuna K. Krishnan, MD, instructor in medicine at Weill Cornell Medicine, told Healio. “Therefore, interventions to improve holistic management of COPD as a multimorbid condition, particularly in Black women, are needed.”
For the study, published in Annals of the American Thoracic Society, Krishnan and colleagues sought to evaluate mortality differences in COPD by race and sex, as well as the underlying mechanisms for these differences. They used Medicare claims to identify COPD among REGARDS cohort participants, calculating mortality rates via adjudicated causes of death.
The analysis included 2,148 patients with COPD (mean age, 71.8 years ± 7.7), of whom 49% were women and 34% were Black.
During follow-up (median, 7.5 years), 1,326 deaths occurred.
All-cause mortality per 1,000 person-years was similar for Black (101.1; 95% CI, 88.3-115.8) and white (93.9; 95% CI, 86.3-102.3) men, with a similar trend in all-cause mortality observed among women (Black, 74.2; 95% CI, 65-84.8; white, 70.6; 95% CI, 63.5-78.5).
For all race-sex groups, cardiovascular disease was the leading cause-specific mortality, accounting for 30% of deaths.
Age-adjusted CVD mortality per 1,000 person-years was highest for Black (30.9; 95% CI, 24.2-39.5) and white (28.3; 95% CI, 24.3-33.1) men, with no difference in the HR for CVD and chronic lung disease mortality between these groups.
For women, age-adjusted CVD mortality per 1,000 person-years was higher among those who were Black (25.4; 95% CI, 20.2-31.9) compared with white (18.7; 95% CI, 15.2-22.9), for an HR for CVD mortality among Black women of 1.44 (95% CI, 1.06-1.95).
However, the reverse trend was seen for chronic lung disease death (mortality per 1,000 person years, Black: 5.7 vs. white: 13.2; P = .01; adjusted HR = 0.44; 95% CI, 0.25-0.77). These differences, according to researchers, were the result of a higher CVD risk factor burden in Black women.
“The paradigm in COPD management is shifting to thinking of the disease as more of a multisystem condition with several coexisting chronic diseases,” Krishnan told Healio. “Our findings indicate that this is especially important to consider when caring for Black women with COPD.”
For more information:
Jamuna K. Krishnan, MD, can be reached at jkk9002@med.cornell.edu; Twitter: @jkkrishnanmd.