Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a growing public health problem in the southern United States, particularly in Alabama. However, very little is known about specific health risk factors disproportionately impacting Alabamians with COPD. We conducted a latent class analysis of 2015–2019 Behavioral Risk Factor Surveillance System data from 4057 Alabamians with COPD (White = 2947, Black = 873, Other = 237). Eighteen risk indicators were examined across three health-related domains: (1) comorbidities, (2) limited healthcare access, and (3) substance use/abuse. Racial disparities between Black and white Alabamians with COPD were assessed using configural similarity analysis. Findings showed that almost one-third (31%) of Alabamians with COPD were in the high-risk class for eight comorbidities, and nearly one-half (48.88%) belonged to the high-risk class for limited healthcare access. Black Alabamians with COPD who did not have health insurance were much more likely to be at high risk for limited healthcare access (94.44%) when compared to their counterparts with insurance (5.56%), χ2(df = 2) = 1389.94, p < 0.0001. Furthermore, the proportion of high-risk, uninsured Black Alabamians with COPD (94.44%) substantially exceeded the percentage of high-risk, uninsured white Alabamians with COPD (59.70%). Most Alabamians with COPD (82.97%) were at low risk for substance use/abuse. Future research should explore new mechanisms for facilitating better healthcare access among high-risk Alabamians living with COPD and other prevalent comorbidities. Greater attention should be focused on Black Alabamians with COPD who cannot afford adequate health insurance.
Highlights
Adults living with Chronic Obstructive Pulmonary Disease (COPD) experience dyspnea and excessive mucus production, perpetuating a vicious cycle of symptomatic living that adversely impacts physical and mental health [1,2,3]
We developed a list of ≈18 Behavioral Risk Factor Surveillance System (BRFSS) risk indicators potentially linked to health disparities disproportionately affecting Black Americans with COPD [15,16,22]: (1) comorbidities; (2) substance use and abuse; and (3) limited access to healthcare
The latent class modeling (LCM) for the entire sample (n = 4057) suggested the best fit was for three latent classes in comorbidity, substance use/abuse, and classes in comorbidity, substance use/abuse, and limited healthcare access domains
Summary
Adults living with Chronic Obstructive Pulmonary Disease (COPD) experience dyspnea (i.e., shortness of breath) and excessive mucus production, perpetuating a vicious cycle of symptomatic living that adversely impacts physical and mental health [1,2,3]. States in the southern U.S report some of the worst COPD outcomes [5]. Alabama has the second-highest state prevalence of COPD in the entire U.S, with nearly 10% of the state’s population (i.e., close to 400,000 Alabamians) likely to be living with COPD [6]. 53 out of every 100,000 Alabamians die from COPD each year [8]. The cost of treatment for COPD in Alabama is approximately $543 million [9]
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