Ding Bo, DiBonaventura Marco, Karlsson Niklas, Ling Xia
Department of Global Medical Affairs, AstraZeneca, Gothenburg, Sweden.
Department of Health Outcomes Practice, Kantar Health, New York, NY, USA.
Int J Chron Obstruct Pulmon Dis. 2016 Jun 9;11:1139-50. doi: 10.2147/COPD.S103873. eCollection 2016.
Research has suggested a significant burden for patients with asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). However, few studies have studied this population in the People's Republic of China, a region in the midst of rapid epidemiological change with respect to respiratory disease. The aim of this study was to assess the prevalence of ACOS and its association with patient outcomes in urban China.
Data from the 2010, 2012, and 2013 China National Health and Wellness Survey, an Internet-based survey of adults in urban China, were used (N=59,935). Respondents were categorized into one of four groups based on self-reported physician diagnoses: ACOS, asthma only, COPD only, or control (ie, no asthma or COPD). A propensity score matching procedure was conducted to cull the control group into a subgroup (ie, matched controls) who resembled patients with ACOS, asthma only, and COPD only. These four groups (ACOS, asthma only, COPD only, matched controls) were then compared with respect to health status (Short Form-12 version 2/Short Form-36 version 2), work productivity, and health care resource use using generalized linear models.
Patients with ACOS (N=366) comprised 0.61% of the adult population, 30.73% of the asthma population, and 18.60% of the COPD population in the People's Republic of China. Patients with ACOS reported significantly worse health status (eg, health utilities =0.63, 0.66, 0.63, and 0.69 for ACOS, COPD only, asthma only, and matched controls, respectively) and significantly greater work impairment (eg, overall work impairment =43.65%, 35.19%, 48.55%, and 29.80%, respectively) and health care resource use (eg, physician visits in the past 6 months =5.13, 3.84, 4.65, and 2.39, respectively) compared with matched controls and patients with COPD only. Few significant differences were observed between patients with ACOS and asthma only.
Patients with ACOS have a greater comorbidity burden and significantly worse health outcomes compared with COPD only patients and matched controls. Better management of these patients may help to improve their outcomes.
研究表明，哮喘-慢性阻塞性肺疾病（COPD）重叠综合征（ACOS）患者负担沉重。然而，在中国这个呼吸系统疾病流行病学正在迅速变化的地区，很少有研究针对这一人群展开。本研究旨在评估中国城市地区ACOS的患病率及其与患者预后的关联。
使用2010年、2012年和2013年中国国家健康与福祉调查的数据，这是一项针对中国城市成年人的基于互联网的调查（N = 59,935）。根据自我报告的医生诊断，将受访者分为四组之一：ACOS、仅患哮喘、仅患COPD或对照组（即无哮喘或COPD）。进行倾向得分匹配程序，将对照组筛选为一个与ACOS患者、仅患哮喘患者和仅患COPD患者相似的亚组（即匹配对照组）。然后使用广义线性模型比较这四组（ACOS、仅患哮喘、仅患COPD、匹配对照组）在健康状况（简短形式-12第2版/简短形式-36第2版）、工作生产力和医疗资源使用方面的情况。
ACOS患者（N = 366）占中国成年人口的0.61%，占哮喘患者的30.73%，占COPD患者的18.60%。与匹配对照组和仅患COPD的患者相比，ACOS患者报告的健康状况明显更差（例如，健康效用值分别为ACOS组0.63、仅患COPD组0.66、仅患哮喘组0.63和匹配对照组0.69），工作受损程度明显更高（例如，总体工作受损率分别为43.65%、35.19%、48.55%和29.80%），医疗资源使用也明显更多（例如，过去6个月的就诊次数分别为5.13、3.84、4.65和2.39）。ACOS患者与仅患哮喘的患者之间未观察到显著差异。
与仅患COPD的患者和匹配对照组相比，ACOS患者的合并症负担更重，健康结局明显更差。更好地管理这些患者可能有助于改善其预后。
