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Direct Medical Expenditures and Healthcare Utilizations in US Hispanic vs. Non-Hispanic Patients with Chronic Obstructive Pulmonary Disease (COPD): An Analysis of the Medical Expenditure Panel Survey 2012-2016

Chronic Obstructive Pulmonary Disorder (COPD) has been the
fourth leading cause of mortality in the United States since 2014
[1]....


Introduction
Chronic Obstructive Pulmonary Disorder (COPD) has been the fourth leading cause of mortality in the United States since 2014 [1]. Approximately 16 million people in the United States are reported to be experiencing symptoms of COPD [1]. This disease is characterized by two major distinguishing factors: emphysema and chronic bronchitis. Emphysema results from damage to the alveoli in the lungs, and chronic bronchitis refers to long-term inflammation of the bronchial tubes. Patients with COPD have trouble eliminating carbon dioxide from their lungs. The majority of patients experiencing symptoms are on appropriate inhaled medications in order to maintain normal breathing, and proper lung function [2]. According to National Vital Statistics, COPD is projected to move up the list of leading causes of death by 2020 [3].
In the United States, the Hispanic population is among the fastest-growing in the nation. Such people have migrated from different countries with various ethnic backgrounds, but regardless, Hispanics are still among the populations most at risk of developing Chronic Obstructive Pulmonary Disorder [1,5]. According to 2015 statistics, 3% of the US Hispanic population has been diagnosed with COPD [3]. A 9-year update conducted by Diaz concluded that Hispanics have a disproportionate possibility of encountering risk factors, including geographical location, genetic susceptibility and social disparities [4]. Quite often, the minority group discussed reside in rural communities in the United States, possibly exposing them to various environmental chemicals, such as biomass smoke [3,4]. The disproportionate prevalence of the disease can be in part attributed to racial ancestry, access to healthcare, and the patient's own disease management perceptions [2,6,7].
In this subset of the population, socio-economic factors could impact the diagnosis and management of COPD [8]. Poor management or delayed diagnosis may significantly increase health care utilization costs. Patients with poorly managed COPD have high all-cause healthcare utilization costs when compared to patients with well-managed COPD [9]. The costs have been increased from $21,771 in patients with zero exacerbations to $47,061 in patients with three or more exacerbations [10,11]. COPD related health care utilization costs has increased by 24-fold when compared to other medical causes [9]. Low socio-economic groups and lack of health insurance can increase out-of-pocket costs and burden the healthcare system [12]. This widespread disease has led to a substantial increase in costs for patient treatment, according to Dalal, ranging from $2,003 to around $43,000 per in-patient visit in the United States [13]. In addition to an overall increase in prevalence of the disease, according to previous research done by Borrego, Hispanics had statistically significantly longer in-patient hospital stays. This led to substantially higher costs to the patient [14]. The aim of this study is to analyze and compare the direct medical expenditures and health care utilizations in US Hispanic patients versus Non-Hispanic patients with COPD. This study will establish credible results regarding the disparities between the examined populations, which can then be applied or considered in future studies regarding similar ethnic disparities. Significant findings may support the hypothesis of disproportionate treatment of Hispanics with COPD, which needs addressing and change, in order to establish an equitable healthcare system.

Statistical Analyses
Descriptive statistics (t-tests for continuous variables and Rao-Scott chi-square tests for categorical variables) were conducted to compare the Hispanic and Non-Hispanic groups.        0.31-0.49), p<0.001) ( Table 6).

Conclusion
This study provided some of the first concrete financial figures concerning this healthcare disparity between ethnicities in the context of COPD-related costs among Hispanic and Non-Hispanic population in the US. It also revealed a possible anomaly in the healthcare system; i.e., Non-Hispanics spend substantially more on COPD-related healthcare than Hispanics. Also, the study demonstrates the necessity of assessing the Charlson Comorbidity Index (CCI) scores. These scores, which indicate compounded comorbidities, seemed to be better indications of the possible health of the participants. The results of our study demonstrate that non-Hispanics with COPD have higher healthcare utilization costs compared to Hispanics with COPD. While the overall amount spent on healthcare by Hispanics is less, it emphasizes the need for better management in this subset of the population to minimize the future harm and to establish a fair healthcare system for all Americans.