Shatto Julie A, Stickland Michael K, Soril Leslie J J
Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada.
Medicine Strategic Clinical Network-Respiratory Health Section, Alberta Health Services, Alberta, Canada.
Chronic Obstr Pulm Dis. 2024 Mar 26;11(2):229-246. doi: 10.15326/jcopdf.2023.0441.
Health inequities among individuals with chronic obstructive pulmonary disease (COPD) are often associated with differential access to health care and health outcomes. A greater understanding of the literature concerning such variation is necessary to determine where gaps or inequities exist along the continuum of COPD care.
A rapid review of the published and grey literature reporting variations in health care access and/or health outcomes for individuals with COPD was completed. Variation was defined as differential patterns in access indicators or outcome measures within sociodemographic categories, including age, ethnicity, geography, race, sex, and socioeconomic status. Emergent themes were identified from the included literature and synthesized narratively.
Thirty-five articles were included for final review; the majority were retrospective cohort studies. Twenty-five studies assessed variation in access to health care. Key indicators included: access to spirometry testing, medication adherence, participation in pulmonary rehabilitation, and contact with general practitioners and/or respiratory specialists. Twenty-one studies assessed variation in health outcomes in COPD and key metrics included: hospital-based resource utilization (length of stay and admissions/readmissions), COPD exacerbations, and mortality. Patients who live in rural environments and those of lower socioeconomic status had both poorer access to care and outcomes at the system and patient level. Other sociodemographic variables, including ethnicity, race, age, and sex were associated with variation in health care access and outcomes, although these findings were less consistent.
The results of this rapid review suggest that substantial variation in access and outcomes exists for individuals with COPD, highlighting opportunities for targeted interventions and policies.
慢性阻塞性肺疾病(COPD)患者之间的健康不平等现象通常与获得医疗保健的机会差异以及健康结果有关。为了确定在COPD护理连续过程中何处存在差距或不平等,有必要更深入地了解有关此类差异的文献。
对已发表和灰色文献进行了快速回顾,这些文献报告了COPD患者在获得医疗保健和/或健康结果方面的差异。差异被定义为社会人口统计学类别(包括年龄、种族、地理位置、种族、性别和社会经济地位)内获得医疗保健指标或结果测量的不同模式。从纳入的文献中识别出新兴主题并进行叙述性综合。
35篇文章被纳入最终审查;大多数是回顾性队列研究。25项研究评估了获得医疗保健的差异。关键指标包括:肺活量测定测试的可及性、药物依从性、参与肺康复治疗以及与全科医生和/或呼吸专科医生的接触。21项研究评估了COPD患者健康结果的差异,关键指标包括:基于医院的资源利用(住院时间和入院/再入院情况)、COPD急性加重和死亡率。生活在农村环境中的患者以及社会经济地位较低的患者在系统和患者层面获得护理的机会和结果都较差。其他社会人口统计学变量,包括种族、民族、年龄和性别,与获得医疗保健的差异和结果有关,尽管这些发现不太一致。
本次快速回顾的结果表明,COPD患者在获得医疗保健和健康结果方面存在很大差异,突出了有针对性的干预措施和政策的机会。