COPD in Hispanics: Uncovering the Disparities and Charting a Course for Better Care
"A 9-year update reveals the unique challenges and opportunities in managing Chronic Obstructive Pulmonary Disease within Hispanic communities."
Chronic Obstructive Pulmonary Disease (COPD) poses a significant public health challenge in both the United States and Latin America. Given the increasing prevalence and unique characteristics of COPD within Hispanic populations, understanding the nuances of this condition in these communities is crucial. This article provides a 9-year update on COPD in Hispanics, building upon previous research to highlight key advances and remaining gaps in knowledge.
The term 'Hispanic' encompasses a diverse group of individuals with ancestry tracing back to Spain or Spanish-controlled territories. This diversity extends to various factors such as country of origin, nativity, and racial ancestry, all of which influence COPD risk and outcomes. Recognizing these differences is paramount for effective prevention and management strategies.
This article will delve into the demographic characteristics and social determinants of health affecting Hispanic populations, examine lung function measures and COPD burden, review recent studies on risk factors, diagnosis, and management of COPD in Hispanics, and discuss future directions in this vital field.
COPD Burden and Early Disease
According to the National Health Interview Survey, the age-adjusted prevalence of diagnosed COPD among U.S. adults aged 18 and older was 3.8% in 2023. Women had a higher prevalence than men, 4.1% versus 3.4%, and prevalence increased from 0.4% among adults ages 18–24 to 10.5% among adults age 75 and older. A separate analysis used baseline data from the Hispanic Community Health Study/Study of Latinos, including 16,415 Hispanic/Latino individuals ages 18–74, to examine early COPD among participants younger than 50.
Evidence Gaps and Subgroup Variation
Existing evidence indicates that COPD prevalence and morbidity vary widely among Hispanic-American nations, while findings among Hispanic subgroups in the United States remain limited. Research has also reported inconsistent data on pulmonary function in Hispanic patients with COPD. Hispanic-focused studies have been proposed to clarify the omics of COPD and how variables correlated with racial ancestry may affect COPD and lung function, including spirometry.
From Broad Categories to Defined Subgroups
Earlier work argued that COPD research and public health policy should focus more directly on Hispanic subgroups. A 2018 nine-year update reiterated the goal of improving COPD prevention, diagnosis, and treatment among Hispanics in the United States and Latin America. Foundational recommendations also called for large studies with subgroups defined by self-reported ethnicity, country of origin, area of residence, and tobacco use.
Unmasking COPD Disparities: What Makes Hispanics Unique?
Compared to other ethnic groups, Hispanics often face socioeconomic challenges such as lower educational attainment, income, health insurance coverage, and English proficiency, all of which can significantly impede access to healthcare and exacerbate health outcomes. In Latin America, disparities in gross domestic product (GDP) and healthcare spending across countries further complicate the landscape of COPD management.
- COPD Prevalence: While overall COPD prevalence may appear lower in Hispanics compared to other groups, significant differences exist among subgroups. Puerto Ricans and Cubans exhibit higher rates compared to Mexicans.
- Genetic Factors: Recent studies have identified potential susceptibility loci for COPD in Hispanics, including genes related to alpha-1 antitrypsin deficiency and others identified through genome-wide association studies.
- Environmental Influences: Hispanics are disproportionately exposed to air pollution due to living near major highways. Exposure to biomass from cooking and heating with wood or coal is also a significant risk factor in Latin America.
Barriers, Heritage, and Regional Care
Recent research describes cultural and socioeconomic barriers that contribute to disparities in COPD diagnosis and treatment among Hispanic adults in the United States, including unequal access to health and preventive services. The early-COPD literature emphasizes that Hispanic/Latino ethnicity includes multiple heritage backgrounds, including Mexicans, Cubans, and Puerto Ricans. A 2024 review reports that COPD creates a substantial burden in Latin America, while management and treatment have progressed slowly and inhalation therapy remains an important focus. A 2025 economic-impact abstract reports that Hispanic smokers are more likely than Caucasians to be underdiagnosed, linking underdiagnosis with worse outcomes and higher long-term healthcare costs.
Limitations in Prevalence and Spirometry Comparisons
Some evidence reports a lower prevalence of obstructive lung disease among Hispanics than among non-Hispanic whites, but this comparison does not resolve differences within Hispanic populations. Pulmonary-function findings in Hispanic patients with COPD have been inconsistent across studies. A major limitation in historical assessment was that spirometry reference equations were available for Mexican Americans but not, until recently, for other U.S. Hispanic groups.
The Future of COPD Care for Hispanics: A Path Forward
Managing COPD in Hispanics requires a multifaceted approach that addresses both individual and systemic factors. Improving health insurance coverage, coupled with culturally sensitive policies that tackle language proficiency, health literacy, and adherence to therapy, is essential. Increased emphasis should be placed on effective smoking cessation interventions tailored to the unique needs of this population.
Ethnicity, Smoking, and Mortality
One study examined the relationship between Hispanic ethnicity, COPD mortality, and smoking behavior in a stable cohort of Hispanics and non-Hispanic whites. The analysis accounted for competing cardiovascular disease risk to assess whether smoking behavior differed by ethnicity and influenced COPD mortality. Another cited study included 17,782 Hispanic adults aged 45 years and older, while the available evidence overall continues to describe pulmonary-function findings as inconsistent.
Forecasting the COPD Burden
Future COPD planning is increasingly using projection models to examine how disease burden may change over time. One study applies a Bayesian Age-Period-Cohort model to forecast global COPD burden trends over the next 20 years. Its stated goal is to provide evidence for researchers and policymakers developing targeted interventions suited to the circumstances of different regions.
Ongoing research initiatives, such as the HCHS/SOL study, combined with future observational studies and clinical trials, are crucial for drawing firm conclusions about the etiology and management of COPD in Hispanic subgroups. These studies should explore the “omics” of COPD, the impact of racial ancestry, and the role of non-tobacco products.
By addressing the specific challenges and leveraging the strengths within Hispanic communities, we can pave the way for more effective prevention, diagnosis, and treatment of COPD, ultimately reducing healthcare disparities and improving the respiratory health of this growing population.