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      The Association between Risk Factors and Chronic Obstructive Pulmonary Disease in Canada: A Cross-sectional Study Using the 2014 Canadian Community Health Survey

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          Abstract

          Background:

          The global prevalence of chronic obstructive pulmonary disease (COPD) is expected to increase and the disease is projected to be the third leading cause of death by the year 2020. The purpose of this study was to measure the prevalence and determine the risk factors for COPD in Canada.

          Methods:

          This is a cross-sectional study that uses data from a nationally generalizable survey, the Canadian Community Health Survey, 2014. There were 46,924 respondents aged 35 years or older. Uni- and multi-variate logistic regression analyses were conducted to determine the risk factors associated with COPD.

          Results:

          The overall prevalence of COPD in the surveyed population was 5.69%. Results from multivariate logistic regression showed that COPD was significantly higher among individuals who were 65 years or older (odds ratio [OR] =4.43; 95% confidence interval [CI]: 3.69–5.33), current smokers (OR = 5.13; 95% CI: 4.43–5.95), underweight or obese by body mass index ([OR = 1.81; 95% CI: 1.38–2.38] and [OR = 1.58; 95% CI: 1.41–1.77], respectively), with a total personal income of <$20,000 (OR = 3.67; 95% CI: 2.95–4.57,), and some postsecondary education (OR = 1.42; 95% CI: 1.14–1.76). Immigrants were less likely to have COPD compared to Canadian-born respondents (OR = 0.67; 95% CI: 0.57–0.79).

          Conclusions:

          COPD is a growing and serious public health issue in Canada. The risk factors identified in this study provide useful targets to health promotion and education initiatives, health-care providers, and public health organizations to decrease the prevalence of COPD.

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          Most cited references35

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          Inequalities in access to medical care by income in developed countries.

          Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.
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            Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.

            Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.
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              Chronic obstructive pulmonary disease and socioeconomic status: a systematic review.

              Along with age and sex, socioeconomic status is one of the most powerful determinants of health. We conducted a systematic review to examine the consistency and magnitude of the association between socioeconomic status and COPD health outcomes to determine the potential impact of SES disparity on the COPD population. Electronic databases to October 2011 were searched for studies of adults who had or were at risk for COPD that quantified an association between a measure of socioeconomic status and at least one COPD health outcome. Two authors independently reviewed studies, assessed study quality, and for eligible studies, extracted data. Regardless of the population, socioeconomic status measure or COPD outcome examined, with few exceptions, consistent significant inverse associations between socioeconomic status and COPD outcomes were found. Most studies found that individuals of the lowest socioeconomic strata were at least twice as likely to have poor outcomes as those of the highest (range from no difference to 10-fold difference). Social and economic disadvantage appears to have a significant consistent impact on COPD mortality and morbidity. These findings point to the need for public health strategies and research to address socioeconomic status disparity in individuals with COPD.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Medknow Publications & Media Pvt Ltd (India )
                2008-7802
                2008-8213
                2017
                24 October 2017
                : 8
                : 86
                Affiliations
                [1] School of Public Health, University of Saskatchewan, Saskatoon, Canada
                Author notes
                Address for correspondence: Dr. John Moraros, School of Public Health University of Saskatchewan, 104 Clinic Place, E-Wing Health Sciences, Room 3320 Saskatoon, SK, S7N 2Z4, Canada. E-mail: john.moraros@ 123456usask.ca
                Article
                IJPVM-8-86
                10.4103/ijpvm.IJPVM_330_17
                5672655
                bed7d0fb-0529-4641-afd9-3b3817ea8e0a
                Copyright: © 2017 International Journal of Preventive Medicine

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 01 August 2017
                : 07 September 2017
                Categories
                Original Article

                Health & Social care
                body mass index,canada,chronic obstructive pulmonary disease,education,smoking,socioeconomic status

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