Smoking Patterns in African Americans and Whites With Advanced COPD

Wissam M. Chatila, MD, FCCP; Walter A. Wynkoop, MD; Gwendolyn Vance, RN; Gerard J. Criner, MD, FCCP


CHEST. 2004;125(1) 

In This Article


Records of 160 patients were included in the final analysis. From an original group of 94 African-American patients, we identified 40 African-American men and 40 African-American women with moderate-to-severe COPD. Fourteen patients were excluded because of coexistent restrictive defects or concomitant heart disease. A random sample of 40 white men and 40 white women, all fitting our selection criteria, from a database of 430 white patients was then compared to the African-American patients.

Patient characteristics at time of referral are shown in Table 1 . When compared to whites, African- American patients were younger at time of referral, started smoking later in life, and had fewer total pack-years of smoking (Fig 1). No differences were noted in BMI, severity of the airflow limitation, maximal exercise performance, and measurement of gas exchange.

Race, smoking, and gas exchange. *African Americans were significantly younger at presentation than white patients (p = 0.002). †African Americans smoked significantly less than white patients (p < 0.001). ‡African Americans started smoking later in life than white patients (p = 0.047).PY = pack-years.

When the identical genders of each race were combined, differences in smoking between male and female patients were noted. Female patients were younger at the time of referral, smoked less, and tended to start smoking at an older age (17.6 ± 4.7 years vs 16.7 ± 4.4 years, p = 0.12; Fig 2). However, despite similar lung function (FEV1 29 ± 10% predicted vs 28 ± 10% predicted, p = 0.43) and exercise capacity ( o2max 41 ± 13% predicted vs 44 ± 14% predicted, p = 0.23), women were more hypercapnic compared to men (Paco2 49.0 ± 10.5 mm Hg vs 45.2 ± 7.3 mm Hg, p = 0.03). There was no difference in BMI between male and female patients (24.1 ± 4.7 vs 25.1 ± 4.7, respectively; p = 0.64)

Gender, smoking, and gas exchange. *Women presented at an earlier age compared to men (58 ± 9 years vs 62 ± 8 years, p = 0.04). †Women smoked less than their male counterparts (49 ± 28 pack-years vs 61 ± 29 pack-years, p = 0.007). ‡Women were more hypercapnic than men (p = 0.03). There was a trend for women to start smoking at a later age than men (17.6 ± 4.7 years vs 16.7 ± 4.4 years, p = 0.12). See Figure 1 legend for expansion of abbreviation.

Intraracial Gender Comparisons. There were 40 patients in each race/gender subgroup. Gender differences in the two racial groups were not similar. White men smoked more than white women (74 ± 30 pack-years vs 57 ± 30 pack-years, p = 0.03), and men tended to start smoking at a younger age (15.6 ± 3.8 years vs 17.6 ± 4.1 years, p = 0.13; Fig 3). White patients, regardless of gender, presented at the same age (Fig 3) and had comparable lung function (Fig 4), gas exchange, and exercise performance (Fig 5). However, no differences were noted between African-American men and women in smoking pattern (Fig 3), pulmonary function (Fig 4), and maximal o2 during exercise (Fig 5).

Race, gender, and smoking. *There was a trend for white men to be older at presentation compared to African-American men (p = 0.06). †White men smoked more than white women and African Americans (p = 0.03 and < 0.001, respectively). ‡White men tended to start smoking earlier compared to African-American men (p = 0.08).

Race, gender, and pulmonary function tests. No differences were noted between all subgroups. Fem = female patients; TLC = total lung capacity; RV = residual volume.

Race, gender, gas exchange, and exercise. No differences were noted between all subgroups. For blood gas analysis, n = 40 per subgroup. Vo2 = o2 at maximal exercise.

Interracial Gender Comparisons. White men and women smoked more than their African-American counterparts (74 ± 30 pack-years vs 47 ± 22 pack-years for men [p < 0.001] and 57 ± 30 pack-years vs 42 ± 25 pack-years for women [p = 0.03]). African-American women tended to present at an earlier age compared to white women (56 ± 10 years vs 60 ± 9 years, p = 0.17). There was also a trend for African-American men to present at a younger age and to start smoking at a later age than white men (59 ± 9 years vs 64 ± 7 years [p = 0.06] and 18.0 ± 4.8 years vs 15.6 ± 3.8 years [p = 0.08], respectively). Further subgroup analysis between African-American men and white men found no racial/gender differences in pulmonary function, gas exchange, and exercise performance.


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