An Official American Thoracic Society/European Respiratory Society Policy Statement: Disparities in Respiratory Health

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Abstract

Health disparities, defined as a significant difference in health between populations, are more common for diseases of the respiratory system than for those of other organ systems, because of the environmental influence on breathing and the variation of the environment among different segments of the population. The lowest social groups are up to 14 times more likely to have respiratory diseases than are the highest. Tobacco smoke, air pollution, environmental exposures, and occupational hazards affect the lungs more than other organs, and occur disproportionately in ethnic minorities and those with lower socioeconomic status. Lack of access to quality health care contributes to disparities.

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Most cited references 13

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Hospital admissions and chemical composition of fine particle air pollution.

Michelle L. Bell, Keita Ebisu, Roger Peng … (2009)

There are unexplained geographical and seasonal differences in the short-term effects of fine particulate matter (PM(2.5)) on human health. The hypothesis has been advanced to include the possibility that such differences might be due to variations in the PM(2.5) chemical composition, but evidence supporting this hypothesis is lacking. To examine whether variation in the relative risks (RR) of hospitalization associated with ambient exposure to PM(2.5) total mass reflects differences in PM(2.5) chemical composition. We linked two national datasets by county and by season: (1) long-term average concentrations of PM(2.5) chemical components for 2000-2005 and (2) RRs of cardiovascular and respiratory hospitalizations for persons 65 years or older associated with a 10-microg/m(3) increase in PM(2.5) total mass on the same day for 106 U.S. counties for 1999 through 2005. We found a positive and statistically significant association between county-specific estimates of the short-term effects of PM(2.5) on cardiovascular and respiratory hospitalizations and county-specific levels of vanadium, elemental carbon, or nickel PM(2.5) content. Communities with higher PM(2.5) content of nickel, vanadium, and elemental carbon and/or their related sources were found to have higher risk of hospitalizations associated with short-term exposure to PM(2.5).

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Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review.

Sang Lee, Jennifer Melvin, M. Griffin (2009)

This paper examines the prevalence of tobacco use among sexual minorities in the US through a systematic review of literature from 1987 to May 2007. Seven databases were searched for peer-reviewed research (Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library via Wiley InterScience, Education Resources Information Center (ERIC), Health Source: Nursing/Academic, Institute for Scientific Information (ISI) Web of Science, PsycINFO via EBSCO Host and PubMed). No language restrictions were used. Abstracts were identified in the literature search (n = 734) and were independently read and coded for inclusion or exclusion by two reviewers. When agreement was not reached, a third reviewer acted as arbitrator. Abstracts were included if they presented data collected in the US from 1987 to May 2007 and reported prevalence or correlation of tobacco use with sexual minority status. Studies reporting data from HIV-positive samples were excluded. The identified articles (n = 46) were independently read by two reviewers who recorded key outcome measures, including prevalence and/or odds ratios of tobacco use, sample size and domain of sexuality (identity, behaviour, or desire). Factors relating to study design and methodology were used to assess study quality according to nine criteria. In the 42 included studies, 119 measures of tobacco prevalence or association were reported. The available evidence points to disparities in smoking among sexual minorities that are significantly higher than among the general population. Ongoing, targeted interventions addressing smoking among sexual minorities are warranted in tobacco control programs.

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Social Determinants of Health and Tobacco Use in Thirteen Low and Middle Income Countries: Evidence from Global Adult Tobacco Survey

Krishna M Palipudi, Prakash Gupta, Dhirendra Sinha … (2012)

Background Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. Methodology/Principal Findings We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008–2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. Conclusions/Significance These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries.