停电：COPD 加重的一个被忽视的风险因素。
Power Outage: An Ignored Risk Factor for COPD Exacerbations.
机构信息
Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY.
Department of Geography, Kent State University, Kent, OH.
出版信息
Chest. 2020 Dec;158(6):2346-2357. doi: 10.1016/j.chest.2020.05.555. Epub 2020 Jun 2.
BACKGROUND
COPD is the third leading cause of death in the United States, with 16 million Americans currently experiencing difficulty with breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations.
RESEARCH QUESTION
The goal of this study was to determine how power outages affect COPD exacerbations.
STUDY DESIGN AND METHODS
Using distributed lag nonlinear models controlling for time-varying confounders, the hospitalization rate during a power outage was compared vs non-outage periods to determine the rate ratio (RR) for COPD and its subtypes at each of 0 to 6 lag days in New York State from 2001 to 2013. Stratified analyses were conducted according to sociodemographic characteristics, season, and clinical severity; changes were investigated in numerous critical medical indicators, including length of stay, hospital cost, the number of comorbidities, and therapeutic procedures between the two periods.
RESULTS
The RR of COPD hospitalization following power outages ranged from 1.03 to 1.39 across lag days. The risk was strongest at lag and lag days and lasted significantly for 7 days. Associations were stronger for the subgroup with acute bronchitis (RR, 1.08-1.69) than for cases of acute exacerbation (RR, 1.03-1.40). Compared with non-outage periods, the outage period was observed to be $4.67 thousand greater in hospital cost and 1.38 greater in the number of comorbidities per case. The average cost (or number of comorbidities) was elevated in all groups stratified according to cost (or number of comorbidities). In contrast, changes in the average length of stay (-0.43 day) and the average number of therapeutic procedures (-0.09) were subtle.
INTERPRETATION
Power outages were associated with a significantly elevated rate of COPD hospitalization, as well as greater costs and number of comorbidities. The average cost and number of comorbidities were elevated in all clinical severity groups.
背景
在美国，COPD 是导致死亡的第三大原因，目前有 1600 万美国人呼吸困难。对于依赖电力的人来说，停电可能会危及生命。然而，对于停电对 COPD 恶化的潜在影响，人们的认识仍存在显著差距。
研究问题
本研究旨在确定停电如何影响 COPD 恶化。
研究设计与方法
本研究使用分布滞后非线性模型，控制随时间变化的混杂因素，比较了纽约州 2001 年至 2013 年期间停电期间与非停电期间的住院率，以确定每个滞后 0 至 6 天的 COPD 及其亚型的发病率比值（RR）。根据社会人口统计学特征、季节和临床严重程度进行分层分析；在两个时期之间，调查了许多关键医疗指标的变化，包括住院时间、住院费用、合并症数量和治疗程序。
结果
停电后 COPD 住院的 RR 在滞后天数范围内为 1.03 至 1.39。在滞后和滞后天数的风险最强，并且持续显著 7 天。在急性支气管炎亚组（RR，1.08-1.69）的关联强于急性加重（RR，1.03-1.40）。与非停电期相比，停电期的住院费用增加了 4670 美元，每例合并症的数量增加了 1.38。根据成本（或合并症数量）分层的所有组中，平均成本（或合并症数量）均升高。相比之下，平均住院时间（-0.43 天）和平均治疗程序（-0.09）的变化很小。
解释
停电与 COPD 住院率显著升高有关，同时还增加了成本和合并症数量。所有临床严重程度组的平均成本和合并症数量均升高。
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