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Reviews conclude women may be more susceptible to smoking-related lung damage, and in many countries the rate of COPD in women has been rising as womens smoking prevalence changed

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Suggestions that this may be due to a biological cause (melanin levels having an effect on nicotine metabolism) have been questioned, and it has suggested that if an effect is present it may be more attributable to social discrimination as a result of colorism, with further research needed to rule out sociological factors