Do social determinants of HEALTH and inequality in health affect the severity of chronic obstructive pulmonary disease (COPD)?

Aim: Chronic obstructive pulmonary disease (COPD) is a disease that results from various dynamic gene-environment interactions, such as lifelong exposure to harmful particles or gases, and abnormal lung development. It is a common, preventable and treatable respiratory disease. COPD is a heterogeneous disease that can vary greatly from patient to patient and can show variability in the same patient in the process, and is known as the third most common cause of death in the world. Since the middle of the 20th century, when globalization (neoliberalism) and free market economy (capitalism) gradually increased their influence, it has been observed that chronic diseases, including COPD, have increased gradually. This increase is thought to be related to the increasing differences in the social, economic and environmental determinants of health. Although the majority of COPD cases live in low-middle-income countries, it is known that international diagnosis and treatment guidelines are generally prepared with the data of developed countries and socioeconomic differences between individuals and societies are not given sufficient importance. In this study, it was aimed to investigate the effect of SDH and health inequalities revealed by these determinants on the severity of COPD. Method: Between 01.09.2020-01.09.2021, in Izmir Dokuz Eylul University Faculty of Medicine Pulmonary Diseases Polyclinic, Pulmonary Diseases Service or Emergency Service; among the cases evaluated by pulmonary diseases physicians, the cases with a diagnosis of COPD were included in the study. In the retrospective evaluation, cases whose findings were compatible with asthma or interstitial lung disease (ILD) or who died, and cases who did not accept to participate in the study were excluded from the study. Characteristics of the cases such as age, gender, body mass index (BMI), exposure history, warming type, place of residence, presence of additional disease, educational status, income level, social class; were compared with multivariate logistic regression analysis models in terms of frequent exacerbations, perception of dyspnea, and severity of airway obstruction. Results: In our study with 167 cases, 18% of the cases were female (n=30) and 82% were male (n=137). It was determined that 41.9% of the cases experienced frequent exacerbations in the last 1 year, 63.5% had a perception of high-intensity dyspnea, and 40.7% had a severe or very severe 'forced expiratory volume in 1 second' (FEV1) percentage. It was observed that there is an inversely proportional relationship between being diagnosed with anxiety and pulmonary hypertension (PHT) and the severity of the disease.It was determined that the subjects with low education level, economic status or social class or using biomass fuel as a heating method had 2 to 28 times worse COPD outcomes than the other subjects. Conclusion: This study, showing the negative effects of SDH and health inequality on COPD, suggested that socioeconomic differences among the risk factors of disease severity in COPD should be examined first, and that COPD treatment is beyond medical treatment. There is a need for a national field study investigating the prevalence of COPD which is known to be the fourth most common cause of death in our country, risk factors of COPD, and the impact of SDH on disease development, disease severity, and mortality risk. Keywords: Chronic obstructive pulmonary disease, inequality in health, social class, social determinants of health, socioeconomic status