Steiner Michael C, Lowe Derek, Beckford Katy, Blakey John, Bolton Charlotte E, Elkin Sarah, Man William D-C, Roberts C Michael, Sewell Louise, Walker Paul, Singh Sally J
Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University Hospitals of Leicester NHS Trust, Leicester, UK.
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians of London, London, UK.
Thorax. 2017 Jun;72(6):530-537. doi: 10.1136/thoraxjnl-2016-209376. Epub 2017 Jan 11.
Pulmonary rehabilitation (PR) improves exercise capacity and health status in patients with COPD, but many patients assessed for PR do not complete therapy. It is unknown whether socioeconomic deprivation associates with rates of completion of PR or the magnitude of clinical benefits bequeathed by PR.
PR services across England and Wales enrolled patients to the National PR audit in 2015. Deprivation was assessed using Index of Multiple Deprivation (IMD) derived from postcodes. Study outcomes were completion of therapy and change in measures of exercise performance and health status. Univariate and multivariate analyses investigated associations between IMD and these outcomes.
210 PR programmes enrolled 7413 patients. Compared with the general population, the PR sample lived in relatively deprived neighbourhoods. There was a statistically significant association between rates of completion of PR and quintile of deprivation (70% in the least and 50% in the most deprived quintiles). After baseline adjustments, the risk ratio (95% CI) for patients in the most deprived relative to the least deprived quintile was 0.79 (0.73 to 0.85), p<0.001. After baseline adjustments, IMD was not significantly associated with improvements in exercise performance and health status.
In a large national dataset, we have shown that patients living in more deprived areas are less likely to complete PR. However, deprivation was not associated with clinical outcomes in patients who complete therapy. Interventions targeted at enhancing referral, uptake and completion of PR among patients living in deprived areas could reduce morbidity and healthcare costs in such hard-to-reach populations.
肺康复（PR）可改善慢性阻塞性肺疾病（COPD）患者的运动能力和健康状况，但许多接受PR评估的患者并未完成治疗。目前尚不清楚社会经济剥夺是否与PR的完成率或PR所带来的临床益处程度相关。
2015年，英格兰和威尔士的PR服务机构将患者纳入全国PR审计。使用从邮政编码得出的多重剥夺指数（IMD）评估剥夺情况。研究结果包括治疗的完成情况以及运动表现和健康状况指标的变化。单因素和多因素分析调查了IMD与这些结果之间的关联。
210个PR项目纳入了7413名患者。与普通人群相比，PR样本居住在相对贫困的社区。PR完成率与剥夺五分位数之间存在统计学上的显著关联（最贫困五分位数中的完成率为50%，最不贫困五分位数中的完成率为70%）。经过基线调整后，最贫困五分位数患者相对于最不贫困五分位数患者的风险比（95%CI）为0.79（0.73至0.85），p<0.001。经过基线调整后，IMD与运动表现和健康状况的改善无显著关联。
在一个大型国家数据集中，我们发现生活在更贫困地区的患者完成PR的可能性较小。然而，剥夺与完成治疗的患者的临床结局无关。针对提高贫困地区患者PR的转诊率以及接受率和完成率的干预措施，可能会降低这些难以接触人群的发病率和医疗成本。
