Medidas Generales en el Tratamiento del TCE Grave

Increased risk of COPD exacerbation and mortality have been linked with SEP measured by age, ethnicity, education, employment and income (Eisner et al., 2005). This association may be explained in part by the greater proportion of smokers among people in lower SEP (Hollingsworth and Martin 2011), although, smoking may not explain all of the associations (Esiner et al., 2006; TorresDuque et al., 2008; Hollingsworth and Martin 2011).

6.2.1 Socio-demographic Factors

In the current study, high proportions of females, those above 35 years old, whites, other race groups, singles, widowed/separated, non-high school graduates, unable to work participants and those with income <$15000 reported COPD in the bivariate analyses. Earlier studies have revealed that individuals of lower SEP were at least twice more likely to experience poor COPD outcomes (Tao et al., 1992; Prescott and Vestbo 1999; Prescott et al., 1999; Gershon et al., 2012). Also, Eisner et al. (2010) identified a strong and consistent relationship between poorer COPD outcomes and low SEP in the US. Although a significant relationship was observed between ethnicity and COPD in the current study, the proportion of blacks that reported COPD was lower than whites and other race participants.

Age was observed as a significant predictor of COPD as the reporting of COPD was observed to increase progressively as age increases. This was supported by evidence from the findings of Cazzola et al. (2011) and Mannino and Buist (2007). However, it

was noted that because most studies of COPD consider populations over the age of 35 years old, it might have increased the effect size of their findings (Mannino and Buist 2007). In the current study participants aged 18 to over 65 years old were considered in the analyses.

6.2.2 Indoor Environmental Factors

The main findings for the bivariate associations between indoor environmental factors and COPD were the significant relationships observed between mold growth, smoking status, smoke indoors, saw mice in the past 30 days, occupational exposure and increased risk of COPD. While there is evidence that individuals with lower education, unemployed and inadequate income are at higher risk of developing COPD due to frequent exposures to poor indoor environmental conditions such as mold presence, mice and cockroach allergens, indoor air pollution and high smoking prevalence (Tao et al., 1992; Prescott and Vestbo 1999; Prescott et al., 1999). Questions remain on which of these environmental factors are the most important. In the current study, the most significant predictors of increased risk of reporting COPD in addition to socio- demographic factors are being a current or former smoker, smoking indoors and exposure to chemicals, fumes and dust in a previous job (occupational exposure). Although smoking has been identified as a dominant risk factor for the development of COPD (Eisner et al., 2006; Hollingsworth and Martin 2011), recent evidence supports the possibility that, the most important global risk factor for COPD is exposure to indoor air pollution (TorresDuque et al., 2008). According to Balmes et al. (2003), occupational exposure accounts for approximately 15% of non-tobacco related COPD in the U.S. The increased risk of COPD in the work environment is a result of exposure to high levels of fumes, chemicals and dust (Hollingsworth and Martin 2011).

6.2.3 Mediation Test for COPD

In the mediating analysis, I found that disparities in the reporting of COPD among adults in different age, marital, education, employment and income groups can be completely or partially explained by being a current or former smoker, smoking indoors and exposure to chemicals, fumes and dust in a previous job. Suggesting that the effects of age, marital status, education, employment, income on the reporting of COPD among ACBS respondents are influenced by being a current or former smoker, smoking indoors and occupational exposure. These findings suggest that disparities in the reporting of COPD are likely to be multi-factorial due to the difference in SEP (Gershon et al., 2012).

The significant predictor-mediator interaction effects revealed that there is a differential gender, age, education, employment and income effects of being a current or former smoker, smoking indoors, occupational exposure on the reporting of COPD among adults. More specifically the analysis revealed that females who reported smoking indoors were more likely to report COPD. While participants who were 35 years or older, non-high school graduates and those with income <$50000 who reported smoking inside and occupational exposure were more likely to report COPD. Unable to work participants who did not report occupational exposure were less likely to report COPD compared to participants who reported occupational exposure. Increased odds of reporting COPD were observed for current and former smokers who were 45 years or older, non-high school and high school graduates. Low SEP and poor housing conditions have been linked to increased risk of COPD (Prescott and Vestbo1999; Hegewald and Crapo 2007; Yin et al., 2011; Gershon et al., 2012). While Zhou et al. (2009) did not observe any relationship between females and increased risk of COPD, they observed that being male of advanced age with low education, having exposure to

environmental tobacco smoke, coal and/or biomass smoke and poor ventilation were all independently associated with a higher risk of having COPD among non-smokers. The increased risk of COPD with age could be attributed not only to the accumulative effect of different risk factors over time but also to the age-related weakening of respiratory muscles (Kojima et al., 2005; Zhou et al., 2009).

Although the magnitudes of the effects of the relationships varied widely across different factors and groups. The findings of this study supported the concept of the social causation of health inequality and the hypothesis that reporting of COPD among adults in different social, economic and demographic groups might be mediated by one or more indoor environmental factors. Also, the findings provide some answers to the question about which indoor environmental factors influence the relationship between socio-demographic factors and COPD. Given this, the findings of the current study contributes to existing knowledge on the risk of COPD among adults because it reveals that the effect of age, marital status, education, employment and income on the reporting of COPD is completely or partially explained by being a current or former smoker, smoking indoors and occupational exposure. These findings also contribute to knowledge in that the significant predictor-mediator interaction effects revealed that the impact of female gender, those 35 years or older, with low education, inadequate employment and low income on the reporting of COPD among adult ACBS respondents depends on smoking status, smoking indoors and occupational exposure. These findings are significant as it highlights specific factors that should be targeted by policymakers to reduce the burden of COPD among adults in the U.S.