University of Michigan Health System, Ann Arbor, MI.
National Jewish Health, Denver, CO; University of Colorado Denver, Denver, CO.
Chest. 2011 Nov;140(5):1169-1176. doi: 10.1378/chest.10-2869. Epub 2011 Jun 2.
Although COPD is associated with significant health-related quality-of-life (HRQL) impairment, factors influencing HRQL in patients with COPD are not well understood, particularly in African Americans. We hypothesized that HRQL in COPD differs by race and sought to identify factors associated with those differences.
We analyzed 224 African American and 1,049 Caucasian subjects with COPD enrolled in the COPDGene (Genetic Epidemiology of COPD) Study whose conditions were classified as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to IV. HRQL and symptoms were compared using the St. George Respiratory Questionnaire (SGRQ) and the modified Medical Research Council Dyspnea (MMRC) scale. We constructed a mixed-effects linear regression model for SGRQ score.
African Americans were younger and reported fewer pack-years of smoking, more current smoking, and less attained education than Caucasians; MMRC scores were higher (P = .02) as were SGRQ scores (mean score difference, 8.4; P < .001). In a general linear model of SGRQ total score after adjusting for factors such as age, sex, and pack-years of smoking, SGRQ total score was similar for African Americans and Caucasians who reported no COPD exacerbations in the prior year. However, for subjects with exacerbations, SGRQ total score was increased to a greater relative extent for African Americans than for Caucasians (1.89 points for each exacerbation, P = .006). For hospitalized exacerbations, the effect on SGRQ total score also was greater for African Americans (4.19 points, P = .04). Furthermore, a larger percentage of African Americans reported having had at least one exacerbation that required hospitalization in the prior year (32% vs 16%, P < .001).
In analyses that account for other variables that affect quality of life, HRQL is similar for African Americans and Caucasians with COPD without exacerbations but worse for African Americans who experience exacerbations, particularly hospitalized exacerbations.
虽然 COPD 与显著的健康相关生活质量（HRQL）损害有关，但影响 COPD 患者 HRQL 的因素尚不清楚，特别是在非裔美国人中。我们假设 COPD 患者的 HRQL 因种族而异，并试图确定与这些差异相关的因素。
我们分析了 COPDGene（COPD 的遗传流行病学）研究中 224 名非裔美国人和 1049 名白种人 COPD 患者的数据，这些患者的病情被分类为 GOLD（慢性阻塞性肺疾病全球倡议）I 至 IV 期。使用圣乔治呼吸问卷（SGRQ）和改良医学研究委员会呼吸困难量表（MMRC）比较 HRQL 和症状。我们构建了一个混合效应线性回归模型来评估 SGRQ 评分。
非裔美国人比白种人年轻，吸烟量少，目前吸烟多，受教育程度低；MMRC 评分较高（P=0.02），SGRQ 评分也较高（平均评分差异为 8.4；P<0.001）。在调整年龄、性别和吸烟量等因素后的 SGRQ 总分一般线性模型中，在过去一年中没有 COPD 加重的非裔美国人和白种人 SGRQ 总分相似。然而，对于有加重的患者，SGRQ 总分的增加程度对非裔美国人来说比白种人更大（每次加重增加 1.89 分，P=0.006）。对于住院加重的患者，SGRQ 总分的影响对非裔美国人来说也更大（4.19 分，P=0.04）。此外，过去一年中，有更多的非裔美国人报告至少有一次需要住院治疗的加重（32% vs 16%，P<0.001）。
在考虑影响生活质量的其他变量的分析中，没有加重的 COPD 非裔美国人和白种人患者的 HRQL 相似，但有加重的非裔美国人患者的 HRQL 较差，特别是有住院加重的患者。
