中国西南农村地区慢性阻塞性肺疾病患病率和经济负担趋势的社会经济差异。
Socioeconomic differentials of trends in the prevalence and economic burden of chronic obstructive pulmonary disease 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. 2023 Jan 20;23(1):141. doi: 10.1186/s12889-023-15096-x.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity, and imposes a substantial financial burden on society. However, few studies have examined the role of individual socioeconomic status (SES) in temporal trends of COPD prevalence and economic cost. This study aimed to uncover the changing prevalence and economic burden of COPD across socioeconomic gradients in rural southwest China.
METHODS
Data were collected from two cross-sectional health interviews and examination surveys administered 10 years apart among individuals aged ≥ 35 years in rural China. A prevalence-based cost-of-illness method was used to estimate the cost of COPD. The individual socioeconomic position (SEP) index was constructed using principal component analysis. Post-bronchodilator spirometry tests were performed for each participant.
RESULTS
From 2011 to 2021, the prevalence of COPD increased from 8.7% to 12.8% (P < 0.01), while the economic cost of COPD increased 1.9-fold. Unit hospital costs and outpatient costs increased 1.57-fold and 1.47-fold, while unit medication costs fell by 10.6%. Increasing prevalence was also observed when the data were stratified by sex, age, ethnicity, level of education, level of income, and SEP (P < 0.05). Men, ethnic minorities, and those with a lower educational level, lower income, or lower SEP had a higher prevalence of COPD than their counterparts both in 2011 and 2021 (P < 0.05). Unit outpatient costs and medication costs increased with patients' SEP in both survey years (P < 0.05).
CONCLUSIONS
The prevalence and economic costs of COPD increased substantially across all socioeconomic gradients in rural southwest China in the decade from 2011 and 2021. Future COPD prevention and management interventions as well as efforts to improve access to affordable COPD medication and treatment should focus in particular on ethnic minority and low SEP populations.
背景
慢性阻塞性肺疾病（COPD）是导致死亡率和发病率的主要原因，给社会带来了巨大的经济负担。然而，很少有研究探讨个体社会经济地位（SES）在 COPD 患病率和经济成本的时间趋势中的作用。本研究旨在揭示中国西南农村地区社会经济梯度中 COPD 患病率和经济负担的变化趋势。
方法
本研究数据来自于中国农村地区进行的两次相隔 10 年的横断面健康访谈和体检调查，纳入年龄≥35 岁的个体。采用基于患病率的疾病成本法来估计 COPD 的成本。采用主成分分析法构建个体社会经济地位（SEP）指数。对每位参与者进行支气管扩张剂后肺功能检查。
结果
2011 年至 2021 年期间，COPD 的患病率从 8.7%上升至 12.8%（P<0.01），而 COPD 的经济成本增加了 1.9 倍。住院单位成本和门诊单位成本分别增加了 1.57 倍和 1.47 倍，而单位药物成本下降了 10.6%。按性别、年龄、种族、受教育程度、收入水平和 SEP 分层时，数据也显示出了发病率的增加（P<0.05）。2011 年和 2021 年，男性、少数民族和受教育程度较低、收入较低或 SEP 较低的人群的 COPD 患病率均高于其他人群（P<0.05）。在两个调查年份，门诊单位成本和药物成本都随患者的 SEP 增加而增加（P<0.05）。
结论
2011 年至 2021 年的十年间，中国西南农村地区所有社会经济梯度的 COPD 患病率和经济成本均显著增加。未来 COPD 的预防和管理干预措施以及改善负担得起的 COPD 药物和治疗的可及性的努力应特别针对少数民族和低 SEP 人群。
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