From the Department of Health Science, the Capstone College of Nursing, the College of Arts and Sciences, and the College of Education, The University of Alabama, Tuscaloosa, and the Department of Behavioral and Community Health, University of Maryland, College Park.
South Med J. 2022 Jun;115(6):374-380. doi: 10.14423/SMJ.0000000000001407.
Educational attainment, income, and race play significant roles in managing and treating patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the impact of these socioeconomic factors and others on the physical and mental distress reported by patients with COPD living in Alabama.
A cross-sectional analysis was completed of Alabama Behavioral Risk Factor Surveillance System 2015-2019 data collected from 4123 respondents who reported that a health professional told them they had COPD, chronic bronchitis, or emphysema. Univariate analyses examined descriptive differences in physical and mental distress among racial groups. Multivariable logistic regression models were used to assess physical and mental distress as a function of race and demographic variables (age, sex, employment status, household income, education level), controlling for dichotomous healthcare access variables (enrollment in a health insurance plan, having a usual source of care, routine check-up in the past 2 years).
Most Alabama adults with COPD from 2015 to 2019 were female (64%) and older than 45 years (88%). Annual incomes were low, with >40% of respondents (43.84%) earning <$20,000/year; adults making between $35,000 and $49,999 were less likely (odds ratio 0.60, 95% confidence interval 0.38-0.96) to experience mental distress. Younger Alabama adults with COPD (25-64 years) were approximately two times more likely than respondents ages 65 and older to report mental distress. African Americans were less likely to report physical distress as compared with Whites (odds ratio 0.61, 95% confidence interval 0.44-0.83). Alabama adults who could not work were more likely than those with COPD who were employed/self-employed, out of work, retired, or identified as homemakers to report physical distress.
Public health and healthcare practitioners across Alabama should use these analyses to direct more targeted, high-yield interventions that will address existing health disparities among state residents living with COPD.
教育程度、收入和种族在管理和治疗慢性阻塞性肺疾病（COPD）患者方面起着重要作用。本研究旨在评估这些社会经济因素以及其他因素对居住在阿拉巴马州的 COPD 患者报告的身心困扰的影响。
对 2015 年至 2019 年阿拉巴马州行为风险因素监测系统收集的 4123 名报告称有医疗保健专业人员告知他们患有 COPD、慢性支气管炎或肺气肿的受访者数据进行了横断面分析。单变量分析检查了不同种族群体之间的身心困扰的描述性差异。多变量逻辑回归模型用于评估种族和人口统计学变量（年龄、性别、就业状况、家庭收入、教育水平）作为身心困扰的函数，同时控制二分类医疗保健获取变量（参加健康保险计划、有常规医疗服务来源、过去 2 年进行常规检查）。
2015 年至 2019 年，阿拉巴马州大多数 COPD 成年人是女性（64%）且年龄超过 45 岁（88%）。年收入较低，超过 40%的受访者（43.84%）年收入<20,000 美元；年收入在 35,000 美元至 49,999 美元之间的成年人不太可能（比值比 0.60，95%置信区间 0.38-0.96）出现精神困扰。与 65 岁及以上的受访者相比，25-64 岁的阿拉巴马州 COPD 年轻成年人报告精神困扰的可能性约为两倍。与白人相比，非裔美国人报告身体不适的可能性较小（比值比 0.61，95%置信区间 0.44-0.83）。无法工作的阿拉巴马州成年人比有 COPD 的在职/自营职业者、失业者、退休者或家庭主妇报告身体不适的可能性更高。
阿拉巴马州的公共卫生和医疗保健从业者应使用这些分析来指导更有针对性、高收益的干预措施，以解决该州 COPD 患者的现有健康差距。
