Clark Alice J, Strandberg-Larsen Katrine, Masters Pedersen Jolenee L, Lange Peter, Prescott Eva, Rod Naja Hulvej
1Institute of Public Health, University of Copenhagen , Copenhagen , Denmark.
COPD. 2015 Apr;12(2):190-8. doi: 10.3109/15412555.2014.922175. Epub 2014 Jun 24.
Only a few smaller studies have addressed the effect of psychosocial factors on risk of chronic obstructive pulmonary disease (COPD) in spite of the potential for psychosocial stress to affect development of the disease through immunological and behavioural pathways. The aim of this study is to determine the relation between various psychosocial risk factors, individually and accumulated, and COPD hospitalisation and deaths. A total of 8728 women and men free of asthma and COPD participating in the Copenhagen City Heart Study, were asked comprehensive questions on major life events, work-related stress, social network, vital exhaustion, economic hardship, and sleep medication in 1991-1993 and followed in nationwide registers until 2009, with <2% loss to follow-up. During follow-up, 461 women and 352 men were hospitalized with or died from COPD. Major life events in adult life and vital exhaustion were both associated with a higher risk of COPD in an exposure-dependent manner, with high vital exhaustion being associated with a hazard ratio [HR] of 2.31 (95% CI 1.69-3.16) for women and 2.48 (1.69-3.64) for men. A higher risk of COPD was also found in participants who experienced economic hardship or had a dysfunctional social network. Furthermore, the accumulation of psychosocial risk factors was associated with a higher risk of COPD in both women (HR = 2.40, 1.78-3.22) and men (HR = 1.93, 1.33-2.80). Psychosocial vulnerability may be important to consider both in clinical practice and when planning future preventive strategies against COPD.
尽管心理社会压力有可能通过免疫和行为途径影响慢性阻塞性肺疾病（COPD）的发展，但只有少数规模较小的研究探讨了心理社会因素对COPD风险的影响。本研究的目的是确定各种心理社会风险因素单独及累积与COPD住院和死亡之间的关系。哥本哈根城市心脏研究中共有8728名无哮喘和COPD的男性和女性参与，在1991 - 1993年被问及有关重大生活事件、工作相关压力、社交网络、极度疲劳、经济困难和睡眠药物的综合问题，并在全国范围内的登记处随访至2009年，随访失访率<2%。在随访期间，461名女性和352名男性因COPD住院或死亡。成年期的重大生活事件和极度疲劳均以暴露依赖的方式与COPD风险较高相关，女性中高极度疲劳与风险比[HR]为2.31（95%CI 1.69 - 3.16）相关，男性中为2.48（1.69 - 3.64）。在经历经济困难或社交网络功能失调的参与者中也发现了较高的COPD风险。此外，心理社会风险因素的累积与女性（HR = 2.40，1.78 - 3.22）和男性（HR = 1.93，1.33 - 2.80）中较高的COPD风险相关。在临床实践和规划未来针对COPD的预防策略时，考虑心理社会易感性可能很重要。
