地理隔离与慢性阻塞性肺疾病相关死亡率的关系：一项队列研究。

Geographic isolation and the risk for chronic obstructive pulmonary disease-related mortality: a cohort study.

机构信息

Veterans Health Administration Office of Rural Health, Veterans Rural Health Resource Center-Central Region, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa 52246-2208, USA.

出版信息

Ann Intern Med. 2011 Jul 19;155(2):80-6. doi: 10.7326/0003-4819-155-2-201107190-00003.

DOI:10.7326/0003-4819-155-2-201107190-00003

PMID:21768581

Abstract

BACKGROUND

Little is known about the possible differences in outcomes between patients with chronic obstructive pulmonary disease (COPD) who live in rural areas and those who live in urban areas of the United States.

OBJECTIVE

To determine whether COPD-related mortality is higher in persons living in rural areas, and to assess whether hospital characteristics influence any observed associations.

DESIGN

Retrospective cohort study.

SETTING

129 acute care Veterans Affairs hospitals.

PATIENTS

Hospitalized patients with a COPD exacerbation.

MEASUREMENTS

Patient rurality (primary exposure); 30-day mortality (primary outcome); and hospital volume and hospital rurality, defined as the mean proportion of hospital admissions coming from rural areas (secondary exposures).

RESULTS

18,809 patients (71% of the study population) lived in urban areas, 5671 (21%) in rural areas, and 1919 (7%) in isolated rural areas. Mortality was increased in patients living in isolated rural areas compared with urban areas (5.0% vs. 3.8%; P = 0.002). The increase in mortality associated with living in an isolated rural area persisted after adjustment for patient characteristics and hospital rurality and volume (odds ratio [OR], 1.42 [95% CI, 1.07 to 1.89]; P = 0.016). Adjusted mortality did not seem to be higher in patients living in nonisolated rural areas (OR, 1.09 [CI, 0.90 to 1.32]; P = 0.47). Results were unchanged in analyses assessing the influence of an omitted confounder on estimates.

LIMITATIONS

The study population was limited to mostly male inpatients who were veterans. Results were based on administrative data.

CONCLUSION

Patients with COPD living in isolated rural areas of the United States seem to be at greater risk for COPD exacerbation-related mortality than those living in urban areas, independent of hospital rurality and volume. Mortality was not increased for patients living in nonisolated rural areas.

PRIMARY FUNDING SOURCE

U.S. Department of Veterans Affairs.

摘要

背景

关于居住在美国农村地区和城市地区的慢性阻塞性肺疾病（COPD）患者，其结局是否存在差异，目前知之甚少。

目的

确定农村地区 COPD 患者的相关死亡率是否更高，并评估医院特征是否会影响任何观察到的关联。

设计

回顾性队列研究。

设置

129 家急性护理退伍军人事务医院。

患者

COPD 加重住院患者。

测量指标

患者居住在农村地区（主要暴露因素）；30 天死亡率（主要结局）；以及医院容量和医院居住在农村地区的比例，定义为医院入院患者中来自农村地区的平均比例（次要暴露因素）。

结果

18809 名患者（研究人群的 71%）居住在城市地区，5671 名（21%）居住在农村地区，1919 名（7%）居住在偏远农村地区。与城市地区相比，居住在偏远农村地区的患者死亡率更高（5.0% vs. 3.8%；P=0.002）。在调整患者特征、医院居住在农村地区的比例和医院容量后，与居住在偏远农村地区相关的死亡率增加仍然存在（比值比[OR]，1.42[95%可信区间，1.07 至 1.89]；P=0.016）。居住在非偏远农村地区的患者调整后死亡率似乎没有更高（OR，1.09[CI，0.90 至 1.32]；P=0.47）。在评估遗漏混杂因素对估计值的影响的分析中，结果保持不变。