Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA.
J Epidemiol Community Health. 2011 Jan;65(1):26-34. doi: 10.1136/jech.2009.089722. Epub 2009 Oct 23.
Although chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes.
The aim of this study is to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD.
Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively).
Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes.
尽管慢性阻塞性肺疾病（COPD）是导致死亡和残疾的常见原因，但对于社会经济地位（SES）和种族对健康结果的影响知之甚少。
本研究旨在确定 SES 和种族对获得医疗保健的 COPD 患者的疾病严重程度、功能障碍和 COPD 急性加重的独立影响。该研究的数据来自 Kaiser Permanente 北加利福尼亚医疗保健计划的 1202 名 COPD 患者的功能、生活、结局和工作队列研究。
在横断面分析中，较低的教育程度和家庭收入与疾病严重程度增加、肺功能更差和身体功能障碍更大相关。黑种人种族与 COPD 严重程度增加有关，但在控制 SES 变量和其他协变量（合并症、吸烟、体重指数和职业暴露）后，这些差异不再明显。较低的教育程度和较低的收入与急性 COPD 加重的前瞻性风险增加独立相关（HR 1.5；95%CI 1.01 至 2.1；和 HR 2.1；95%CI 1.4 至 3.4）。
低 SES 是一系列不良 COPD 健康结果的危险因素。临床医生和疾病管理计划应将 SES 视为不良预后的关键患者水平标志物。
