Robichaux Camille, Aron Jordan, Wendt Chris H, Berman Jesse D, Rau Austin, Bangerter Ann, Dudley R Adams, Baldomero Arianne K
Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA.
Int J Chron Obstruct Pulmon Dis. 2023 Jul 25;18:1587-1593. doi: 10.2147/COPD.S406899. eCollection 2023.
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. Identifying both individual and community risk factors associated with higher mortality is essential to improve outcomes. Few population-based studies of mortality in COPD include both individual characteristics and community risk factors.
We used geocoded, patient-level data to describe the associations between individual demographics, neighborhood socioeconomic status, and all-cause mortality.
We performed a nationally representative retrospective cohort analysis of all patients enrolled in the Veteran Health Administration with at least one ICD-9 or ICD-10 code for COPD in 2016-2019. We obtained demographic characteristics, comorbidities, and geocoded residential address. Area Deprivation Index and rurality were classified using individual geocoded residential addresses. We used logistic regression models to assess the association between these characteristics and age-adjusted all-cause mortality.
Of 1,106,163 COPD patients, 33.4% were deceased as of January 2021. In age-adjusted models, having more comorbidities, Black/African American race (OR 1.09 [95% CI: 1.08-1.11]), and higher neighborhood disadvantage (OR 1.30 [95% CI: 1.28-1.32]) were associated with all-cause mortality. Female sex (OR 0.67 [95% CI: 0.65-0.69]), Asian race (OR 0.64, [95% CI: 0.59-0.70]), and living in a more rural area were associated with lower odds of all-cause mortality. After adjusting for age, comorbidities, neighborhood socioeconomic status, and rurality, the association with Black/African American race reversed.
All-cause mortality in COPD patients is disproportionately higher in patients living in poorer neighborhoods and urban areas, suggesting the impact of social determinants of health on COPD outcomes. Black race was associated with higher age-adjusted all-cause mortality, but this association was abrogated after adjusting for gender, socioeconomic status, comorbidities, and urbanicity. Future studies should focus on exploring mechanisms by which disparities arise and developing interventions to address these.
慢性阻塞性肺疾病（COPD）是全球主要的死亡原因之一。识别与较高死亡率相关的个体和社区风险因素对于改善预后至关重要。很少有基于人群的COPD死亡率研究同时纳入个体特征和社区风险因素。
我们使用地理编码的患者层面数据来描述个体人口统计学、邻里社会经济地位与全因死亡率之间的关联。
我们对2016 - 2019年退伍军人健康管理局登记的所有至少有一个COPD的ICD - 9或ICD - 10编码的患者进行了具有全国代表性的回顾性队列分析。我们获取了人口统计学特征、合并症以及地理编码的居住地址。使用个体地理编码的居住地址对地区贫困指数和农村程度进行分类。我们使用逻辑回归模型来评估这些特征与年龄调整后的全因死亡率之间的关联。
在1,106,163例COPD患者中，截至2021年1月，33.4%已死亡。在年龄调整模型中，合并症更多、黑人/非裔美国人种族（比值比[OR]1.09[95%置信区间：1.08 - 1.11]）以及邻里劣势较高（OR 1.30[95%置信区间：1.28 - 1.32]）与全因死亡率相关。女性性别（OR 0.67[95%置信区间：0.65 - 0.69]）、亚洲种族（OR 0.64，[95%置信区间：0.59 - 0.70]）以及生活在农村地区与全因死亡率较低的几率相关。在调整年龄、合并症、邻里社会经济地位和农村程度后，与黑人/非裔美国人种族的关联发生了逆转。
居住在较贫困社区和城市地区的COPD患者全因死亡率过高，这表明健康的社会决定因素对COPD预后的影响。黑人种族与年龄调整后的全因死亡率较高相关，但在调整性别、社会经济地位、合并症和城市化程度后，这种关联被消除。未来的研究应专注于探索差异产生的机制并制定干预措施来解决这些问题。
