Study finds surprising early COPD risks for US Hispanics/Latinos

Sept. 15, 2021─ A new study published online in the Annals of the American Thoracic Society provides the most exhaustive look to date at the risk factors, prevalence and population attributable risk (PAR) of developing chronic obstructive pulmonary disease (COPD) in U.S. Hispanics/Latinos under age 50.  PAR estimates the proportion of disease attributable to exposure to disease-causing agents, such as smoking.   The researchers used PAR to calculate the burden of early COPD that would be eliminated if the exposure did not take place.    

In “Prevalence and Population Attributable Risk for Early COPD in U.S. Hispanics/Latinos,” Alejandro A. Diaz, MD, MPH, assistant professor of medicine at Harvard Medical School and associate scientist at the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, and colleagues examined data on 7,323 individuals under age 50 who participated in the Hispanic Community Health Study/Study of Latinos to identify risk factors and estimate early COPD prevalence using statistical tools (logistic regression analysis).  The team estimated PARs of the risk factors.

“We used PAR to calculate the burden of early COPD that would be eliminated if the environmental exposure was eliminated,” said Dr. Diaz. “This information might help the decision-making process to allocate resources to public health programs, such as smoking cessation.”  

Five hundred twenty-four survey respondents met the criteria for early COPD. After adjusting for sex and age, the researchers found a 7.6 percent prevalence of COPD in this age group.  Having asthma, having ever smoked and chronic sinusitis were associated with increased odds of developing COPD before age 50.  Asthma was the most important early COPD risk factor, followed by smoking status and chronic sinusitis.

Dr. Diaz stated, “This is one of the largest studies showing an association between chronic sinusitis and early COPD. Chronic sinusitis and early COPD share symptoms (coughing and sputum production), so there may be some diagnostic overlap. We think that the findings may encourage further investigation on the link between these two conditions.”

Another surprising finding:  Immigrants have a lower risk of early COPD than U.S.-born Hispanics/Latinos. 

“One possible reason for this finding is that immigrants, particularly those coming to the U.S. as adults, were less exposed to respiratory hazards during the period of lung development compared to their U.S.-born counterparts,” Dr. Diaz postulated.  “Immigrants tend to be healthier than their home-country population, which likely decreases the risk for chronic respiratory diseases.”

He added, “Other studies demonstrate that most U.S. Hispanics/Latinos live in areas that do not meet standard norms of clean air, so this relationship needs further exploration.”

The authors noted:  “One critical public health measure to reduce early COPD risk is smoking cessation/tobacco treatment (including vaped and other non-burnt tobacco products). Efforts to increase awareness and access to treatment programs are critical. These efforts include culturally sensitive and bilingual (English and Spanish) programs about education, counseling, and therapies for tobacco treatment. Also, measures to reduce exposure to respiratory hazards at work (use of masks, avoidance of irritating cleaning products, etc.) are essential in this population.” 

COPD affects more than 29 million people and is the fourth leading cause of death in the U.S.  COPD develops slowly over many years and is typically diagnosed when individuals are over age 60 and have significant airflow obstruction, making therapies less effective.  Because of this difficulty in treating patients whose disease has progressed, experts have proposed to shift their focus to younger individuals.  In a predominantly white population, early COPD has been linked to higher hospitalization and death rates.  Several studies have identified risk factors in predominantly white older populations, however, early studies of Hispanics/Latinos have been lacking.  This study is one of the largest to explore risk factors for early COPD in Hispanics/Latinos.       

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