Parekh Trisha M, Cherrington Andrea L, Bhatia Smita, Turan Bulent, Patel Siddharth B, Kim Young-Il, Turan Janet M, Dransfield Mark T
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham.
Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham.
Chronic Obstr Pulm Dis. 2020 Apr;7(2):107-117. doi: 10.15326/jcopdf.7.2.2019.0165.
Low-income chronic obstructive pulmonary disease (COPD) individuals are known to have higher rates of COPD-related hospitalizations and readmissions. Levels of psychological stress are also higher in low-income populations and may be associated with acute care use. We sought to: (1) determine the association between stress and acute care use in COPD, (2) evaluate the social determinants of health (SDH) in low and high stress individuals, and (3) determine the association between low income and high stress with acute care use.
Using results from a survey-based study of individuals with COPD at the University of Alabama (UAB), we used multivariable regression modeling to evaluate the association of high stress with acute care use (COPD-related emergency department [ED] visits or hospitalizations). We then compared SDH between low and high stress groups and evaluated the association of low income + high stress with acute care use in a secondary model.
We included 126 individuals in our study. The high stress group was more likely to be < 65 years old and female. No differences in race, smoking, years of smoking, body mass index, dyspnea, or lung function (forced expiratory volume in 1 second [FEV]%) by stress group were observed. The high stress group had a 2.5-fold increased adjusted odds of acute care use (adjusted odds ratio [AOR]95% confidence interval [CI], 2.51, 1.06-5.98) compared to the low stress group, while the low-income + high stress group had a 4-fold increased adjusted odds of acute care use (AOR, 95% CI, 4.38, 1.25-15-45) compared to high-income + low-stress group.
Acute care use and stress are associated in COPD. These associations are more pronounced in the low-income + high stress population who disproportionately contribute to health care utilization and frequently lack the resources needed to cope with stress.
已知低收入慢性阻塞性肺疾病（COPD）患者因COPD相关的住院和再入院率较高。低收入人群的心理压力水平也较高，且可能与急性护理的使用有关。我们旨在：（1）确定压力与COPD急性护理使用之间的关联；（2）评估低压力和高压力个体的健康社会决定因素（SDH）；（3）确定低收入和高压力与急性护理使用之间的关联。
利用阿拉巴马大学（UAB）对COPD患者进行的一项基于调查的研究结果，我们使用多变量回归模型来评估高压力与急性护理使用（COPD相关的急诊科[ED]就诊或住院）之间的关联。然后，我们比较了低压力组和高压力组的SDH，并在一个二级模型中评估了低收入+高压力与急性护理使用之间的关联。
我们的研究纳入了126名个体。高压力组更可能年龄小于65岁且为女性。未观察到不同压力组在种族、吸烟、吸烟年限、体重指数、呼吸困难或肺功能（1秒用力呼气量[FEV]%）方面存在差异。与低压力组相比，高压力组急性护理使用的调整后比值增加了2.5倍（调整后比值比[AOR]95%置信区间[CI]为2.51，1.06 -
