| Autor: |
Krishnan JK; Division of Pulmonary and Critical Care Medicine and., Murphy ML; Internal Medicine and.; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Health System, Miami, Florida., Edgar AS; Division of Pulmonary and Critical Care Medicine and., Aronson KI; Division of Pulmonary and Critical Care Medicine and., Guri A; Pulmonary and Critical Care, Brooklyn Methodist Hospital, Brooklyn, New York., Gross L; Pulmonary and Critical Care, Brooklyn Methodist Hospital, Brooklyn, New York.; Montefiore Nyack Hospital, Nyack, New York; and., Younger T; Graduate Center for Social Welfare, City University of New York, New York, New York., Martinez FJ; Division of Pulmonary and Critical Care Medicine and., Safford MM; Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York. |
| Abstrakt: |
Rationale: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women. However, barriers to CVD prevention from the perspective of Black individuals living with COPD have not been previously identified. Objectives: To identify barriers and facilitators for CVD prevention among Black individuals living with COPD. Methods: We conducted semistructured interviews with Black participants living with COPD and attending clinics at two urban hospitals. Participants were included if they had physician-confirmed COPD diagnoses and presence of CVD or CVD risk factors. Interviews were conducted until thematic saturation was reached, with additional interviews conducted to confirm saturation. Data were analyzed using thematic analysis, iteratively revising and updating the codebook by consensus of the study team. Codes were grouped into categories, subthemes, and themes. Themes were organized using the social ecological framework into individual, interpersonal, health system, and societal levels. Results: We interviewed 30 participants of mean age 67.8 ± 8.3 years; 17 (57%) were Black women and 13 (43%) were Black men. Individual-level themes were that living with COPD and resultant multimorbidity affects CVD prevention (theme 1) and that self-efficacy and advocacy affect care received (theme 2). At the interpersonal level, supportive relationships facilitate improved access to CVD prevention (theme 3). System-level themes were that health systems are not designed to support patients with COPD and CVD (theme 4) and that health systems do not deliver effective patient education (theme 5). At the societal level, structural barriers and racism prevent access to care and adoption of a healthy lifestyle (theme 6). Conclusions: We identified barriers to CVD prevention at all levels of the socioecological framework for Black individuals living with COPD. To maximize their impact, future interventions to prevent CVD among individuals with COPD can use these findings to target barriers at multiple levels. |
