Carlos H Martinez1, David M Mannino2, Jeffrey L Curtis3, MeiLan K Han4, Alejandro A Diaz5. 1. Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI. Electronic address: carlosma@umich.edu. 2. Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, KY; Department of Epidemiology, Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY. 3. Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI. 4. Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI. 5. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors. METHODS: We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV₁/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS. RESULTS: Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites. CONCLUSIONS: Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.
BACKGROUND: Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors. METHODS: We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV₁/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS. RESULTS: Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites. CONCLUSIONS: Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.
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Authors: Carlos H Martinez; David M Mannino; Fabian A Jaimes; Jeffrey L Curtis; MeiLan K Han; Nadia N Hansel; Alejandro A Diaz Journal: Ann Am Thorac Soc Date: 2015-12
Authors: Carlos H Martinez; Alejandro A Diaz; Amit D Parulekar; Stephen I Rennard; Richard E Kanner; Nadia N Hansel; David Couper; Kristen E Holm; Karin F Hoth; Jeffrey L Curtis; Fernando J Martinez; Nicola A Hanania; Elizabeth A Regan; Robert Paine; Christine T Cigolle; MeiLan K Han Journal: Chest Date: 2015-12-17 Impact factor: 9.410