Individuals From Minority Ethnic Backgrounds Had Poor Adherence to Nonsurgical Interventions for COPD

Patients with chronic obstructive pulmonary disease (COPD) who were from minority ethnic backgrounds tend to have lower adherence rates to nonsurgical interventions to treat the disease, according to a review published in ERJ Open Research. This research was done in heterogeneous groups, indicating the need for further investigation of the factors that influence adherence.

COPD can cause respiratory problems such as dyspnea, cough, wheezing, and sputum production due to airflow obstruction. COPD is the third leading cause of death worldwide. Nonsurgical therapies such as smoking cessation and pulmonary rehabilitation benefit patients with COPD in decreasing the severity and frequency of exacerbations as well as improving quality of life. Knowing how ethnic minority groups adhere to these nonsurgical therapies is crucial to predicting hospitalization and death in these groups. This review aimed to determine the inequalities in management of COPD and to identify gaps in knowledge around ethnicity’s influence on adherence.

Study participants were included if they had a COPD diagnosis and were from a minority ethnic group; there was no limit to age, disease stage, or presence of comorbidity. Ethnic minority was defined as any participant who did not speak the language of the country that the study took place in, was an immigrant, or had identified as an ethnic minority.

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Primary research studies, including observational studies and cross-sectional studies, were considered for the review. Studies published in English were the only studies considered for this review. MEDLINE and CINAHL were used to search for studies in a first search, which was extended to Embase on a second check. Data including the aim of the study, its population, its methodology, and the key findings were extracted.

There were 37 studies included in the review after the search, with publication dates ranging from 2003 to 2022. There were 26 studies from the United States, 4 from Denmark, 3 from New Zealand, 2 from the United Kingdom, and 1 each from Canada and Australia. These studies examined interventions including medication adherence, smoking cessation, flu vaccination, rehabilitation of the pulmonary system, and oxygen therapy.

Black and Hispanic ethnic groups were found to be less likely to be adherent to medication for COPD compared with White participants in the 5 studies from the United States; this was found to be statistically significant in 4 of the studies. A higher risk of poor adherence was found in patients who were not ethnic Danes in the 2 studies from Denmark. In another study, patients who identified as Black had higher odds of improper use of their inhaler.

Patients of Black ethnicity were less likely to be currently smoking compared with participants of White ethnicity in the 2 studies from the United Kingdom. Smoking cessation methods were less likely to be used in patients who were not of Danish ethnicity in the 2 studies from Denmark. Non-Hispanic White patients had a higher rate of quitting smoking in the 2 American studies included. Another US-based study found that smoking cessation treatment within 48 hours of discharge from the hospital due to COPD was less likely in patients of Black ethnicity.

Patients of Black ethnicity were less likely to receive the flu vaccine compared with those of White ethnicity who had COPD. In London, South Asian patients were the mostly likely patients to receive the flu vaccine compared with White and Black patients. However, a study from Canada found that there was no significant difference.

Pulmonary rehabilitation was most likely to be received and adhered to in non-Hispanic White patients in 6 studies conducted in the United States. White patients were more likely to receive pulmonary rehabilitation in London compared with South Asian and Black patients. A study conducted in Australia did not find any significant differences between pulmonary rehabilitation and ethnicity. The New Zealand studies found that patients of European origin were more likely to have higher session attendance compared with Māori and Pacific Island patients. The 2 studies that evaluated long-term oxygen therapy had conflicting results, with 1 finding that there was a significant difference between non-Hispanic White patients and other ethnic groups and the other not finding a significant difference.

There are some limitations to this study. The heterogeneity of the studies leads to multiple ways of reporting and collecting data. There were also several ways to define adherence and treatment across all of the studies, which made interpretation of results challenging. Causal relationships could not be assessed due to the observational design.

The researchers concluded that adherence to nonsurgical interventions for COPD varied by ethnic group. Understanding the barriers to adherence in these ethnic groups should be the focus of future research in this area to improve disease outcomes in all patients, they noted.

Reference

Alamer S, Robinson-Barella A, Nazar H, Husband A. Influence of ethnicity on adherence to nonsurgical interventions for COPD: a scoping review. ERJ Open Res. 2023;9(6):00421-2023. doi:10.1183/23120541.00421-2023