Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2021 Jan 5;15:3447-3454. doi: 10.2147/COPD.S276639. eCollection 2020.
Socioeconomic status (SES) is a strong determinant in the development of various diseases. We evaluated the relationship between SES and the incidence of chronic obstructive pulmonary disease (COPD) by using a community-based cohort data.
Four-year follow-up data of 6341 adults (aged ≥ 40 years), who underwent serial pulmonary function test were analyzed. Incidence of COPD in the participants was defined as the absence of airflow obstruction compatible with COPD (pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity ratio of <0.7) at baseline but documentation of airflow obstruction in serial testing. SES of patients was divided into quartiles according to household income and educational level. Multivariate logistic regression analyses were performed to estimate the association between SES and COPD incidence.
A total of 280 (4.4%) patients developed COPD during the follow-up. The proportion of subjects with lowest education (elementary school) and lowest household income levels (1st quartile) was significantly higher in the COPD group than in the non-COPD group (37.9% vs 29.5%, p<0.011 and 48.4% vs 30.8%, p<0.001, respectively). Logistic regression analysis revealed that education level of elementary school was independently associated with COPD incidence after adjustment for sex, age, body mass index, white blood cell count, residence area, and occupation (odds ratio 1.879, 95% confidence interval 1.124-3.141, p=0.016).
In the general population, educational level of elementary school was an independent risk factor for COPD among the components comprising SES. Our results indicate that the implementation of preventive strategies for COPD in those with low educational status could be beneficial.
社会经济地位（SES）是多种疾病发展的重要决定因素。我们利用基于社区的队列数据评估 SES 与慢性阻塞性肺疾病（COPD）发病率之间的关系。
对接受系列肺功能测试的 6341 名年龄≥40 岁成年人的 4 年随访数据进行了分析。研究对象中 COPD 的发病率定义为基线时不存在气流受限，但在系列检测中记录到气流受限，且气流受限与 COPD 相符（支气管扩张剂前 1 秒用力呼气量/用力肺活量比值<0.7）。根据家庭收入和教育程度将患者的 SES 分为四分位。采用多变量逻辑回归分析来评估 SES 与 COPD 发病率之间的关联。
在随访期间，共有 280（4.4%）名患者发生 COPD。在 COPD 组中，受教育程度最低（小学）和家庭收入最低（第 1 四分位数）的患者比例显著高于非 COPD 组（37.9%比 29.5%，p<0.011；48.4%比 30.8%，p<0.001）。Logistic 回归分析显示，在校正性别、年龄、体重指数、白细胞计数、居住区域和职业后，小学教育程度与 COPD 发病率独立相关（比值比 1.879，95%置信区间 1.124-3.141，p=0.016）。
在一般人群中，SES 组成部分中的小学教育程度是 COPD 的独立危险因素。我们的研究结果表明，在教育程度较低的人群中实施 COPD 预防策略可能有益。
