Racial disparities in chronic obstructive pulmonary disease (COPD)

Background: National reports on COPD have been limited to non-Hispanic white, non-Hispanic black, and Hispanic adults because of insufficient numbers of American Indians and Asians in national surveillance systems. Methods: We analyzed self-reported COPD prevalence for adults aged >=25 years from BRFSS, Medicare hospital claims for first-listed COPD diagnosis for ages >=65 years, and COPD as underlying cause for ages >=25 years from death certificates. Age-standardized estimates and 95% confidence intervals were compared among racial/ethnic groups. Results: Age-adjusted prevalence in 2011 was significantly higher among American Indian/Alaska Natives (11.0% [9.5-12.6]) and lower among Asian/Pacific Islanders (2.5% [1.9-3.2]) and Hispanics (4.1% [3.8-4.5]) than among non-Hispanic blacks (6.5% [6.1-7.0]) or non-Hispanic whites (6.9% [6.7-7.1]). Medicare hospitalizations (per 1000 Medicare enrollees) in 2010 were significantly higher among American Indians (13.2 [12.6-13.9]) and blacks (12.4 [12.2-12.5]) and lower among Asians (4.8 [4.6-5.0]) and Hispanics (9.7 [9.5-10.0]) than among whites (11.3 [11.2-11.4]). Death rates (per 100,000 population) in 2010 were significantly higher among non-Hispanic whites (70.2 [69.8-70.6]) compared to other groups but American Indian/Alaska Natives also had higher death rates (62.9 [57.7-68.0] than non-Hispanic blacks (41.8 [40.9-42.8]), Hispanics (28.5 [27.5-29.4]), and Asian/Pacific Islanders (19.0 [17.9-20.0]). Conclusions: COPD is an under-recognized but considerable public health problem among American Indian populations. Explanations for this disparity and identification and demonstration of focused prevention and intervention efforts are needed.