Advanced emphysema in African-American and white patients: do differences exist?

BACKGROUND Emphysema is the only smoking-related disease in which white patients have higher prevalence and higher attributable mortality rates than African-American patients. Epidemiologic studies have not addressed, nor explained, the observed racial differences in emphysema. STUDY OBJECTIVES To determine whether white and African-American patients differ with respect to the magnitude, anatomic distribution, and physiologic impairments of emphysema. PATIENTS Characteristics of patients with severe and very severe emphysema enrolled in the National Emphysema Treatment Trial were examined and compared. Patient demographics, cardiopulmonary function, quality of life, and severity/distribution of the emphysema by quantitative CT were analyzed. RESULTS Of the 1,218 patients enrolled in the trial, 42 were African American (3.4%) and 1,156 were white (95%). African Americans were younger (mean age +/- SD, 63 +/- 7 years vs 67 +/- 6 years) and smoked less (26 +/- 14 cigarettes per day vs 32 +/- 14 cigarettes per day) than white patients (p = 0.01). There was no difference between the two racial groups in pulmonary function (FEV1, 27 +/- 6% predicted vs 27 +/- 7% predicted), gas exchange (Pa(O2), 66 +/- 11 mm Hg vs 65 +/- 10 mm Hg), and exercise (33 +/- 14 W vs 36 +/- 21 W), respectively. Quality of life measures were similar between the groups, but African Americans had a lower socioeconomic status, lower education level, and fewer were married. Radiographic analysis of the extent of emphysema in African Americans, who were matched with selected white patients, revealed significantly less emphysema in the former group and different distribution of severe emphysema. CONCLUSIONS African Americans with emphysema were younger and had a similar degree of lung impairment as the white study population despite smoking less. In a subgroup of matched patients, the severity and distribution of emphysema by quantitative radiographic analysis were different.

[1]  D. Leung,et al.  Racial differences in T-lymphocyte response to glucocorticoids. , 2005, Chest.

[2]  A. Dirksen,et al.  Short‐term reproducibility of computed tomography‐based lung density measurements in alpha‐1 antitrypsin deficiency and smokers with emphysema , 2004, Acta radiologica.

[3]  G. Criner,et al.  Smoking patterns in African Americans and whites with advanced COPD. , 2004, Chest.

[4]  E. Hoffman,et al.  Characterization of the interstitial lung diseases via density-based and texture-based analysis of computed tomography images of lung structure and function. , 2003, Academic radiology.

[5]  Steven Piantadosi,et al.  A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. , 2003, The New England journal of medicine.

[6]  E. Silverman,et al.  Genome-wide linkage analysis of severe, early-onset chronic obstructive pulmonary disease: airflow obstruction and chronic bronchitis phenotypes. , 2002, Human molecular genetics.

[7]  N. Anthonisen,et al.  The role of matrix metalloproteinase polymorphisms in the rate of decline in lung function. , 2002, Human molecular genetics.

[8]  S Bosan,et al.  Core to rind distribution of severe emphysema predicts outcome of lung volume reduction surgery. , 2001, American journal of respiratory and critical care medicine.

[9]  P. Kremsner,et al.  African-European differences in the capacity of T-cell cytokine production. , 2001, The American journal of tropical medicine and hygiene.

[10]  D. Tashkin,et al.  Gender bias in the diagnosis of COPD. , 2001, Chest.

[11]  Eric A. Hoffman,et al.  Automatic lung segmentation for accurate quantitation of volumetric X-ray CT images , 2001, IEEE Transactions on Medical Imaging.

[12]  J. Burdick,et al.  Decreased effect of immunosuppression on immunocompetence in African–Americans after kidney and liver transplantation , 2001, Clinical transplantation.

[13]  H. Shirasawa,et al.  Association of tumor necrosis factor α gene promoter polymorphism with the presence of chronic obstructive pulmonary disease , 2001 .

[14]  T L Petty,et al.  Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. , 2000, Archives of internal medicine.

[15]  S. Janson,et al.  Ethnic differences: word descriptors used by African-American and white asthma patients during induced bronchoconstriction. , 2000, Chest.

[16]  F. Speizer,et al.  Race and gender differences in the effects of smoking on lung function. , 2000, Chest.

[17]  E. Perez-stable,et al.  Ethnic differences in N-glucuronidation of nicotine and cotinine. , 1999, The Journal of pharmacology and experimental therapeutics.

[18]  S Muro,et al.  Comparison of low attenuation areas on computed tomographic scans between inner and outer segments of the lung in patients with chronic obstructive pulmonary disease: incidence and contribution to lung function , 1999, Thorax.

[19]  Steven Piantadosi,et al.  Rationale and design of the national emphysema treatment trial: A prospective randomized trial of lung volume reduction surgery , 1999 .

[20]  Sarah E. Duffy,et al.  Rationale and design of the National Emphysema Treatment Trial (NETT): A prospective randomized trial of lung volume reduction surgery. , 1999, The Journal of thoracic and cardiovascular surgery.

[21]  E. Sellers.  Pharmacogenetics and ethnoracial differences in smoking. , 1998, JAMA.

[22]  Song-Lih Huang,et al.  Tumor Necrosis Factor- α Gene Polymorphism in Chronic Bronchitis , 1997 .

[23]  D A Redelmeier,et al.  Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. , 1997, American journal of respiratory and critical care medicine.

[24]  T. Petty,et al.  Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease. National Heart, Lung, and Blood Institute Workshop Summary. Bethesda, Maryland, August 29-31, 1995. , 1997, JAMA.

[25]  M. Tanemura,et al.  Quantitative assessment of the spatial distribution of low attenuation areas on X-ray CT using texture analysis in patients with chronic pulmonary emphysema. , 1997, Frontiers of medical and biological engineering : the international journal of the Japan Society of Medical Electronics and Biological Engineering.

[26]  L. Gunning-Schepers,et al.  Differences between studies in reported relative risks associated with smoking: an overview. , 1996, Public health reports.

[27]  P. Paré,et al.  Measurement of lung expansion with computed tomography and comparison with quantitative histology. , 1995, Journal of applied physiology.

[28]  John L. Hankinson,et al.  Standardization of Spirometry, 1994 Update. American Thoracic Society. , 1995, American journal of respiratory and critical care medicine.

[29]  P De Vuyst,et al.  Comparison of computed density and macroscopic morphometry in pulmonary emphysema. , 1995, American journal of respiratory and critical care medicine.

[30]  J. Hankinson,et al.  American Thoracic Society. Single-breath carbon monoxide diffusing capacity (transfer factor). Recommendations for a standard technique--1995 update. , 1995, American journal of respiratory and critical care medicine.

[31]  W. Bailey,et al.  Effects of Smoking Intervention and the Use of an Inhaled Anticholinergic Bronchodilator on the Rate of Decline of FEV1 , 1994 .

[32]  W A Kalender,et al.  Standardized quantitative high resolution CT in lung diseases. , 1991, Journal of computer assisted tomography.

[33]  R. Deyo,et al.  Generic and Disease-Specific Measures in Assessing Health Status and Quality of Life , 1989, Medical care.

[34]  P. Remington,et al.  Smoking by blacks and whites: socioeconomic and demographic differences. , 1988, American journal of public health.

[35]  E A Hoffman,et al.  Effect of body orientation on regional lung expansion: a computed tomographic approach. , 1985, Journal of applied physiology.

[36]  George S. Ansell,et al.  Co-Principal Investigators: , 1984 .

[37]  S. Katz,et al.  Is emphysema a disease predominantly of the white male? Preliminary report. , 1962, JAMA.