Revisiting Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome

economic status and poverty in the community were associated with COPD prevalence. The odds of having COPD increased by 8% with every 1-unit decrease in a person’s income-topoverty ratio. People in the South and the Midwest have more COPD. Overall, the prevalence of COPD in rural, poor communities is twice that seen in the general population. Solid fuel use data are included in the census database. Although the overall use of coal or wood for fuel is low in the United States, a community with a 1% increase in the use of these fuels could be linked to a 9% risk in COPD among nonsmokers in the area. Although not statistically significant, crude modeling showed that increased odds of COPD were seen in people reporting working in the agriculture, construction, or mining industries. Minority groups were less likely to report having COPD, but it is not clear whether this is due to being less susceptible, being screened and diagnosed less, or due to other disparities in care. The major limitation of this study is that people self report their diagnosis of COPD. Care was taken to limit misclassification, but the potential for misrepresentation exists. Data about fuel use was collected at the community level and not the individual level, and other potential risk factors could not be individually assessed. These include early childhood infection, moving between geographic areas and access to care. The strength of the study, however, is the robust data available through the various databases and the ability to evaluate both individual and regional trends. The UCHS data, specifically, allowed the stratification of the responses between poor and nonpoor regions—a breakdown that was illustrative. In this nationally representative sample of Americans, the following characteristics were significant risk factors associated with a higher prevalence of COPD: living in a rural area with a high level of poverty in the community. Among nonsmokers, living in a community that uses coal for heating was an additional risk factor.