慢性阻塞性肺疾病（COPD）及其合并症对一般健康相关生活质量的相对影响：COSYCONET患者队列与KORA和SHIP研究中的对照受试者的汇总分析
Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies.
作者信息
Wacker Margarethe E, Jörres Rudolf A, Karch Annika, Koch Armin, Heinrich Joachim, Karrasch Stefan, Schulz Holger, Peters Annette, Gläser Sven, Ewert Ralf, Baumeister Sebastian E, Vogelmeier Claus, Leidl Reiner, Holle Rolf
机构信息
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany.
出版信息
Respir Res. 2016 Jul 12;17(1):81. doi: 10.1186/s12931-016-0401-0.
BACKGROUND
Health-related quality of life (HRQL) is an important patient-reported outcome measure used to describe the burden of chronic obstructive pulmonary disease (COPD) which is often accompanied by comorbid conditions.
METHODS
Data from 2275 participants in the COPD cohort COSYCONET and from 4505 lung-healthy control subjects from the population-based KORA and SHIP studies were pooled. Main outcomes were the five dimensions of the generic EQ-5D-3 L questionnaire and two EQ-5D index scores using a tariff based on valuations from the general population and an experience-based tariff. The association of COPD in GOLD grades 1-4 and of several comorbid conditions with the EQ-5D index scores was quantified by multiple linear regression models while adjusting for age, sex, education, body mass index (BMI), and smoking status.
RESULTS
For all dimensions of the EQ-5D, the proportion of participants reporting problems was higher in the COPD group than in control subjects. COPD was associated with significant reductions in the EQ-5D index scores (-0.05 points for COPD grades 1/2, -0.09 for COPD grade 3, -0.18 for COPD grade 4 according to the preference-based utility tariff, all p < 0.0001). Adjusted mean index scores were 0.89 in control subjects and 0.85, 0.84, 0.81, and 0.72 in COPD grades 1-4 according to the preference-based utility tariff and 0.76, 0.71, 0.68, 0.64, and 0.58 for control subjects and COPD grades 1-4 for the experience-based tariff respectively. Comorbidities had additive negative effects on the index scores; the effect sizes for comorbidities were comparable to or smaller than the effects of COPD grade 3. No statistically significant interactions between COPD and comorbidities were observed. Score differences between COPD patients and control subjects were most pronounced in younger age groups.
CONCLUSIONS
Compared with control subjects, the considerable reduction of HRQL in patients with COPD was mainly due to respiratory limitations, but observed comorbidities added linearly to this effect. Younger COPD patients showed a greater loss of HRQL and may therefore be in specific need of comprehensive disease management.
TRIAL REGISTRATION
NCT01245933.
背景
健康相关生活质量（HRQL）是一种重要的患者报告结局指标，用于描述慢性阻塞性肺疾病（COPD）的负担，COPD常伴有合并症。
方法
汇总了COPD队列研究COSYCONET中2275名参与者以及基于人群的KORA和SHIP研究中4505名肺部健康对照者的数据。主要结局指标为通用的EQ-5D-3L问卷的五个维度以及两个EQ-5D指数得分，分别采用基于普通人群估值的收费标准和基于经验的收费标准。通过多元线性回归模型对1-4级GOLD分级的COPD以及几种合并症与EQ-5D指数得分之间的关联进行量化，同时对年龄、性别、教育程度、体重指数（BMI）和吸烟状况进行校正。
结果
对于EQ-5D的所有维度，报告有问题的参与者比例在COPD组中高于对照组。COPD与EQ-5D指数得分显著降低相关（根据基于偏好的效用收费标准，COPD 1/2级降低0.05分，COPD 3级降低0.09分，COPD 4级降低0.18分，所有p<0.0001）。根据基于偏好的效用收费标准，对照组的校正后平均指数得分为0.89，COPD 1-4级分别为0.85、0.84、0.81和0.72；根据基于经验的收费标准，对照组和COPD 1-4级分别为0.76、0.71、0.68、0.64和0.58。合并症对指数得分有累加的负面影响；合并症的效应大小与COPD 3级的效应相当或更小。未观察到COPD与合并症之间有统计学意义的交互作用。COPD患者与对照组之间的得分差异在较年轻年龄组中最为明显。
结论
与对照组相比，COPD患者HRQL的显著降低主要归因于呼吸功能受限，但观察到的合并症对此效应有线性叠加作用。较年轻的COPD患者HRQL损失更大，因此可能特别需要全面的疾病管理。
试验注册
NCT01245933。
Zotero 插件