School of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia, Australia.
Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.
Respirology. 2018 Aug;23(8):743-749. doi: 10.1111/resp.13280. Epub 2018 Mar 4.
Bronchiectasis not associated with cystic fibrosis is an increasingly recognized chronic lung disease. In Oceania, indigenous populations experience a disproportionately high burden of disease. We aimed to describe the natural history of bronchiectasis and identify risk factors associated with premature mortality within a cohort of Aboriginal Australians, New Zealand Māori and Pacific Islanders, and non-indigenous Australians and New Zealanders.
This was a retrospective cohort study of bronchiectasis patients aged >15 years at three hospitals: Alice Springs Hospital and Monash Medical Centre in Australia, and Middlemore Hospital in New Zealand. Data included demographics, ethnicity, sputum microbiology, radiology, spirometry, hospitalization and survival over 5 years of follow-up.
Aboriginal Australians were significantly younger and died at a significantly younger age than other groups. Age- and sex-adjusted all-cause mortality was higher for Aboriginal Australians (hazard ratio (HR): 3.9), and respiratory-related mortality was higher for both Aboriginal Australians (HR: 4.3) and Māori and Pacific Islander people (HR: 1.7). Hospitalization was common: Aboriginal Australians had 2.9 admissions/person-year and 16.9 days in hospital/person-year. Despite Aboriginal Australians having poorer prognosis, calculation of the FACED score suggested milder disease in this group. Sputum microbiology varied with Aspergillus fumigatus more often isolated from non-indigenous patients. Airflow obstruction was common (66.9%) but not invariable.
Bronchiectasis is not one disease. It has a significant impact on healthcare utilization and survival. Differences between populations are likely to relate to differing aetiologies and understanding the drivers of bronchiectasis in disadvantaged populations will be key.
非囊性纤维化支气管扩张症是一种日益被认识的慢性肺部疾病，在大洋洲，土著人群的疾病负担过高。我们旨在描述支气管扩张症的自然病史，并确定在澳大利亚原住民、新西兰毛利人和太平洋岛民以及非土著澳大利亚人和新西兰人群中与过早死亡相关的危险因素。
这是一项在澳大利亚的爱丽丝泉医院和莫纳什医疗中心以及新西兰的米德尔莫尔医院进行的支气管扩张症患者的回顾性队列研究，患者年龄>15 岁。数据包括人口统计学、种族、痰微生物学、放射学、肺量测定、住院和 5 年随访期间的生存情况。
澳大利亚原住民明显比其他人群年轻，死亡年龄也明显更小。年龄和性别调整后的全因死亡率在澳大利亚原住民中更高（危险比（HR）：3.9），呼吸相关死亡率在澳大利亚原住民（HR：4.3）和毛利人和太平洋岛民中更高（HR：1.7）。住院很常见：澳大利亚原住民的人均住院人数为 2.9 次/人，住院天数为 16.9 天/人。尽管澳大利亚原住民的预后较差，但 FACED 评分的计算表明该组疾病较轻。痰微生物学随曲霉属烟曲霉的出现而变化，非土著患者中更常分离出该菌。气流阻塞很常见（66.9%），但并非不变。
支气管扩张症不是一种疾病。它对医疗保健的利用和生存有重大影响。人群之间的差异可能与不同的病因有关，了解弱势人群中支气管扩张症的驱动因素将是关键。
