Socioeconomic status shaping GOLD A-D classification in patients with chronic obstructive pulmonary disease

Background: Recent studies investigated how health is affected by socio-economic status (SES) in COPD showed that low SES is a risk factor for adverse COPD health outcomes. Accordingly, we conducted this study with a hypothesis of “SES Shaping GOLD A-D Classification in Patients with COPD”. Methods: This is a cross-sectional study including 167 COPD patients. Patients were classified according to the GOLD 2014 Document. Comprehensive socio-demographic and clinical data were collected through the use of a predefined questionnaire. Education, household monthly income, marital status, insurance coverage and place of residence were used as the socio-economic status indicators. Results: Patients had a mean age of 63.1±8.3, FEV1% of 47.2±19, CAT score of 17.6±7.5. 16 (9.6%) of patients were classified as GOLD A, 44 (26.3 %) as GOLD B, 19 (11.4%) as GOLD C, and 88 (52.7%) as GOLD D groups. Significant differences among GOLD A-D groups, in terms of SES, were detected. The rate of patients with lower SES were significantly higher in the patients who have risk of exacerbation (GOLD C and D) compared without exacerbation risk (GOLD A and B) (χ2=9, p=0.029). The number of patients with frequent exacerbation was significantly higher in patients from rural areas and household monthly income. Household monthly income is a strong predictor of risk of exacerbation (p=0.04). Conclusions: This study indicate that low SES is associated with the risk of exacerbation and that it was a important determinant in evaluating patients with COPD according to GOLD A-D classification. Besides clinical factors, SES should be considered as a key patient-level marker in the management of the disease.