Sturdy P M, Victor C R, Anderson H R, Bland J M, Butland B K, Harrison B D W, Peckitt C, Taylor J C
Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE, UK.
Thorax. 2002 Dec;57(12):1034-9. doi: 10.1136/thorax.57.12.1034.
Uncontrolled studies suggest that psychosocial factors and health behaviour may be important in asthma death.
A community based case-control study of 533 cases, comprising 78% of all asthma deaths under age 65 years and 533 hospital controls individually matched for age, district and asthma admission date corresponding to date of death was undertaken in seven regions of Britain (1994-98). Data were extracted blind from anonymised copies of primary care records for the previous 5 years and non-blind for the earlier period.
60% of cases and 63% of controls were female. The median age in both groups was 53. Cases had an earlier age of asthma onset, more chronic obstructive lung disease, and were more obese. 48% of cases and 42% of controls had a health behaviour problem; repeated non-attendance/poor inhaler technique was related to increased risk of death. Overall, 85% and 86%, respectively, had a psychosocial problem. Four psychosocial factors were associated with increased risk of death (psychosis, alcohol/drug abuse, financial/employment problems, learning difficulties) and two with reduced risk (anxiety/prescription of antidepressant drugs and sexual problems). While alcohol/drug abuse lost significance after adjustment for psychosis, other associations appeared independent of each other and of indicators of severity and co-morbidity. None of the remaining 13 factors including family problems, domestic abuse, bereavement, and social isolation were significantly related to risk of asthma death.
There was an apparently high burden of psychosocial problems in both cases and controls. The associations between health behaviour, psychosocial factors, and asthma death are varied and complex with a limited number of factors showing positive relationships.
非对照研究表明，社会心理因素和健康行为在哮喘死亡中可能起重要作用。
在英国七个地区开展了一项基于社区的病例对照研究，纳入533例病例，占65岁以下所有哮喘死亡病例的78%，并选取533名医院对照，这些对照在年龄、地区和哮喘入院日期（对应死亡日期）方面与病例进行个体匹配（1994 - 1998年）。数据从之前5年初级保健记录的匿名副本中盲态提取，更早时期的数据提取则非盲态。
60%的病例和63%的对照为女性。两组的年龄中位数均为53岁。病例组哮喘发病年龄更早，慢性阻塞性肺疾病更多，且更肥胖。48%的病例和42%的对照存在健康行为问题；反复不就诊/吸入器使用技术不佳与死亡风险增加有关。总体而言，分别有85%和86%存在社会心理问题。四个社会心理因素与死亡风险增加相关（精神病、酒精/药物滥用、财务/就业问题、学习困难），两个因素与死亡风险降低相关（焦虑/抗抑郁药物处方和性问题）。虽然在对精神病进行调整后酒精/药物滥用失去了显著性，但其他关联似乎相互独立，且独立于严重程度和共病指标。其余13个因素，包括家庭问题、家庭暴力、丧亲之痛和社会孤立，均与哮喘死亡风险无显著关联。
病例组和对照组中社会心理问题的负担显然都很高。健康行为、社会心理因素与哮喘死亡之间的关联多样且复杂，仅有少数因素显示出正相关关系。
