中国西南农村地区慢性阻塞性肺疾病患病率、诊断和治疗的社会经济差异。
Socioeconomic variations in chronic obstructive pulmonary disease prevalence, diagnosis, and treatment in rural Southwest China.
机构信息
School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Cheng Gong New City, Kunming, 650500, China.
The First Affiliated Hospital of Kunming Medical University, Kunming, China.
出版信息
BMC Public Health. 2020 Apr 19;20(1):536. doi: 10.1186/s12889-020-08687-5.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality throughout the world. However, there remains a limited understanding of the association between individual socioeconomic status (SES) and COPD diagnosis and treatment worldwide, including in China. This study investigates socioeconomic variations in prevalence, diagnosis, and treatment of COPD in rural China.
METHODS
The present study employed a cross-sectional survey design. The study population was composed of Han majority as well as Na Xi and Bai ethnic minority individuals 35 years of age and older living in Yunnan Province from 2017 to 2019. In total, 7534 individuals consented to participate in the study and complete a structured interview as well as a post-bronchodilator spirometry test. Multivariate logistic regression was used to analyze the association between individual socioeconomic status variables and the prevalence, diagnosis, and treatment of COPD.
RESULTS
The age-standardized prevalence of COPD in the present study was 14.3%. Prevalence differed by gender: prevalence for men was 17.1%, versus 11.4% for women (P = 0.0001). Overall, levels of diagnosis and treatment of COPD for participants with COPD were 24.2 and 23.1%, respectively. Multivariate logistic regression indicated that higher educational levels and good access to medical services was associated with an overall lower risk of COPD (P = 0.032 vs. P = 0.018) as well as a higher probability of COPD diagnosis among those with COPD (P = 0.0001 vs. P = 0.002). Participants with COPD with higher educational levels (P = 0.0001) and higher annual household incomes (P = 0.0001) as well as good access to medical services (P = 0.016) were more likely to receive COPD medications and treatment than their counterparts. While Na Xi and Bai participants had a higher probability of having COPD (P = 0.0001), they had a lower probability of having received a diagnosis or treatment for COPD than Han participants (P = 0.0001 vs. P = 0.0012).
CONCLUSIONS
Future interventions to further control COPD and improve diagnosis and treatment should focus on ethnic minority communities, and those with low education levels, low annual household incomes, and poor access to medical services.
背景
慢性阻塞性肺疾病（COPD）是全世界发病率和死亡率的主要且不断增长的原因。然而，全球范围内，包括中国，对于个体社会经济地位（SES）与 COPD 诊断和治疗之间的关联，仍存在有限的了解。本研究调查了中国农村 COPD 的患病率、诊断和治疗方面的社会经济差异。
方法
本研究采用横断面调查设计。研究人群由汉族以及纳西族和白族少数民族 35 岁及以上的个体组成，他们于 2017 年至 2019 年居住在云南省。共有 7534 人同意参加研究并完成了结构化访谈和支气管扩张剂后肺功能检查。多变量逻辑回归用于分析个体社会经济地位变量与 COPD 的患病率、诊断和治疗之间的关联。
结果
本研究中 COPD 的年龄标准化患病率为 14.3%。患病率因性别而异：男性患病率为 17.1%，女性患病率为 11.4%（P=0.0001）。总体而言，COPD 患者的 COPD 诊断和治疗水平分别为 24.2%和 23.1%。多变量逻辑回归表明，较高的教育水平和良好的医疗服务可获得性与 COPD 的总体较低风险相关（P=0.032 与 P=0.018），以及 COPD 诊断的可能性更高（P=0.0001 与 P=0.002）。与那些 COPD 患者相比，具有较高教育水平（P=0.0001）和较高年收入（P=0.0001）以及良好的医疗服务可获得性（P=0.016）的 COPD 患者更有可能接受 COPD 药物治疗。虽然纳西族和白族参与者患有 COPD 的可能性更高（P=0.0001），但他们接受 COPD 诊断或治疗的可能性却低于汉族参与者（P=0.0001 与 P=0.0012）。
结论
未来控制 COPD 以及改善诊断和治疗的干预措施应侧重于少数民族社区，以及教育程度较低、年收入较低和医疗服务较差的人群。
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