Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, China.
J Glob Health. 2023 Dec 1;13:04163. doi: 10.7189/jogh.13.04163.
Education levels play a critical role in the development of chronic obstructive pulmonary disease (COPD), which mainly affects the elderly, who generally have a low level of education in China. We aimed to investigate the association between education level and COPD clinical characteristics and outcomes, especially the effects of education level on the all-cause mortality of COPD in the Chinese population.
We retrieved data collected between December 2016 and June 2020 in the RealDTC, an ongoing multicenter, real-world study on the status of diagnosis and treatment of COPD. The patients were classified into low- and high-education groups. We extracted data on demographics, pulmonary function, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, modified Medical Research Council (mMRC) scores, COPD Assessment Test (CAT) scores, exacerbation history, therapy, and comorbidities, and on mortality during three years of follow-up.
We included 4098 patients with COPD, of whom 3258 (79.5%) were of low education. This group had higher ages, CAT scores, mMRC scores, and numbers of exacerbations, as well as a greater proportion of females, never smokers, biofuel exposure, and GOLD grade 3. Logistic regression showed that being aged ≥65 years, being female, having biofuel exposure, having CAT scores of 20-29, and having ≥2 exacerbations were independently associated with having low education (P < 0.05). Furthermore, low-education COPD patients had a higher cumulative mortality risk during three years of follow-up than their high-education counterparts (hazard ratio (HR) = 1.75; 95% confidence interval (CI) = 1.17-2.61, P = 0.006).
Low-education COPD patients, who accounted for most of our sample, had a higher symptom burden, risk of exacerbation, and risk of all-cause mortality. Clinicians attending COPD patients should be more attentive of individuals with low education levels.
教育水平在慢性阻塞性肺疾病（COPD）的发展中起着至关重要的作用，COPD 主要影响老年人，而中国老年人的受教育水平普遍较低。我们旨在探讨教育水平与 COPD 临床特征和结局之间的关系，特别是教育水平对中国人群 COPD 全因死亡率的影响。
我们检索了 2016 年 12 月至 2020 年 6 月期间正在进行的、多中心、真实世界的 COPD 诊断和治疗现状研究（RealDTC）中收集的数据。患者被分为低教育组和高教育组。我们提取了人口统计学、肺功能、全球倡议慢性阻塞性肺疾病（GOLD）分级、改良的医学研究理事会（mMRC）评分、COPD 评估测试（CAT）评分、加重史、治疗和合并症以及 3 年随访期间的死亡率等数据。
我们纳入了 4098 例 COPD 患者，其中 3258 例（79.5%）为低教育程度。这组患者年龄较大，CAT 评分、mMRC 评分和加重次数较高，女性、从不吸烟者、生物燃料暴露以及 GOLD 分级 3 的比例也较高。Logistic 回归显示，年龄≥65 岁、女性、生物燃料暴露、CAT 评分为 20-29 分和≥2 次加重与低教育程度独立相关（P<0.05）。此外，在 3 年随访期间，低教育程度 COPD 患者的累积死亡率风险高于高教育程度患者（危险比（HR）=1.75；95%置信区间（CI）=1.17-2.61，P=0.006）。
在我们的样本中，大多数低教育程度 COPD 患者的症状负担、加重风险和全因死亡率较高。治疗 COPD 患者的临床医生应更加关注受教育程度较低的个体。
