Blanc Paul D, Eisner Mark D, Yelin Edward H, Earnest Gillian, Balmes John R, Gregorich Steven E, Katz Patricia P
Division of Occupational and Environmental Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA 94143-0924, USA.
Int J Chron Obstruct Pulmon Dis. 2008;3(3):483-90. doi: 10.2147/copd.s3319.
Inequalities in the use of new medications may contribute to health disparities. We analyzed socioeconomic gradients in the use of tiotropium for chronic obstructive pulmonary disease (COPD).
In a cohort of adults with COPD aged > or = 55 years identified through population-based sampling, we elicited questionnaire responses on demographics, socioeconomic status (SES; lower SES defined as high school education or less or annual household income < US $20,000), and medication use and other clinical variables. In a subset we obtained pulmonary function testing. We used multiple logistic regression analysis to estimate the associations between SES and tiotropium use in COPD, adjusting for disease severity measured by a COPD Severity Score.
Of 427 subjects, 44 (10.3%) reported using tiotropium in 2006. Adjusting for COPD severity, lower SES was associated with reduced odds of tiotropium use (OR 0.3; 95% CI 0.1-0.7; p = 0.005). Among the subset with lung function data (n = 95), after including COPD Global Obstructive Lung Disease (GOLD) Stage > or = 2 in the model, lower SES remained associated with reduced odds oftiotropium use (OR 0.03; 95% CI < 0.001-0.7; p = 0.03). Including forced expiratory volume in one second in the model as a continuous variable instead of GOLD Stage > or = 2 yielded similar results for lower SES (OR 0.1; 95% CI < 0.001-0.5; p = 0.02).
There was a strong SES gradient in tiotropium use such that there was less use with lower SES. To the extent that this is an efficacious medication for COPD, this gradient represents a potential source of health disparities.
新药物使用方面的不平等可能导致健康差异。我们分析了慢性阻塞性肺疾病（COPD）患者使用噻托溴铵的社会经济梯度。
通过基于人群的抽样确定了一组年龄≥55岁的COPD成年患者，我们通过问卷调查收集了有关人口统计学、社会经济地位（SES；低SES定义为高中及以下学历或家庭年收入<20,000美元）、药物使用及其他临床变量的信息。在一个子集中，我们进行了肺功能测试。我们使用多元逻辑回归分析来估计SES与COPD患者使用噻托溴铵之间的关联，并根据COPD严重程度评分所衡量的疾病严重程度进行调整。
在427名受试者中，44名（10.3%）报告在2006年使用过噻托溴铵。在调整了COPD严重程度后，低SES与使用噻托溴铵的几率降低相关（比值比[OR]为0.3；95%置信区间[CI]为0.1 - 0.7；p = 0.005）。在有肺功能数据的子集中（n = 95），在模型中纳入COPD全球阻塞性肺疾病（GOLD）2期及以上后，低SES仍然与使用噻托溴铵的几率降低相关（OR为0.03；95% CI<0.001 - 0.7；p = 0.03）。在模型中，将一秒用力呼气容积作为连续变量而非GOLD 2期及以上纳入分析时，低SES得到了类似结果（OR为0.1；95% CI<0.001 - 0.5；p = 0.02）。
在噻托溴铵的使用方面存在很强的SES梯度，即低SES者使用较少。就其为COPD的有效药物而言，这种梯度代表了健康差异的一个潜在来源。
