社会经济地位和表型衰弱与慢性阻塞性肺疾病（COPD）发病的关联：来自英国生物银行参与者的研究结果

Associations of Socioeconomic Status and Phenotypic Frailty With Incident COPD: Findings From UK Biobank Participants.

作者信息

Feng Zhaolong, Li Guoxian, He Qida, Sun Na, Li Tongxing, Han Qiang, Zhao Hanqing, Ma Ze, Sun Mengtong, Liu Boyan, Wang Yu, Lou Zexin, Ma Siqian, Shi Yujie, Li Jianing, Sun Ziqing, Jiang Miao, Shen Yueping

机构信息

Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China; Fourth Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China.

出版信息

Chest. 2025 May;167(5):1321-1332. doi: 10.1016/j.chest.2024.11.004. Epub 2024 Nov 17.

DOI:10.1016/j.chest.2024.11.004

PMID:39551095

Abstract

BACKGROUND

The independent, mediation, interaction, and joint effects of socioeconomic status (SES) and phenotypic frailty on the incidence of COPD are unclear.

RESEARCH QUESTION

Do SES and frailty increase the risk of COPD independently or jointly? Is there an interaction between the 2 factors in incident COPD? Does frailty play a mediating role between SES and COPD?

STUDY DESIGN AND METHODS

This study included 396,106 UK Biobank participants without COPD at baseline. Latent class analysis was used to define the SES of participants. Frailty was defined by the frailty phenotypes according to 5 factors. Cox regression models were used to examine the associations and calculate hazard ratios (HRs) and 95% CIs. Mediation and interaction analyses were used to explain the associations between SES and frailty on COPD risk.

RESULTS

During a median follow-up period of 13.5 years, 12,626 individuals were diagnosed with COPD. Compared with high SES or robust individuals, low SES (HR, 2.69; 95% CI, 2.48-2.92) or frailty (HR, 2.75; 95% CI, 2.58-2.93) increased the risk of COPD, respectively; 11.80% of the association between SES and COPD was mediated by frailty. In addition, there was a statistically significant additive interaction of low SES and frailty with COPD incidence (relative risk due to interaction, 3.591; 95% CI, 2.189-4.992; attributable proportion due to the interaction, 0.433; 95% CI, 0.276-0.589). Compared with robust individuals with high SES, frail individuals with low SES have the highest risk of COPD (HR, 7.85; 95% CI, 6.96-8.86).

INTERPRETATION

Our findings indicate that low SES and frailty are independent risk factors for COPD, and these 2 factors also have synergistic interaction in COPD. Frailty partially mediated the association between SES and COPD. Thus, the early identification and reversal of frailty may minimize the risk of COPD, especially in individuals with low SES.

摘要

背景

社会经济地位（SES）和表型衰弱对慢性阻塞性肺疾病（COPD）发病率的独立、中介、交互和联合作用尚不清楚。

研究问题

SES和衰弱是独立还是联合增加COPD风险？这两个因素在COPD发病中是否存在交互作用？衰弱在SES和COPD之间是否起中介作用？

研究设计与方法

本研究纳入了396,106名基线时无COPD的英国生物银行参与者。采用潜在类别分析来定义参与者的SES。根据5个因素的衰弱表型来定义衰弱。使用Cox回归模型检验关联并计算风险比（HRs）和95%置信区间（CIs）。采用中介和交互分析来解释SES和衰弱与COPD风险之间的关联。

结果

在中位随访期13.5年期间，12,626人被诊断为COPD。与高SES或健壮个体相比，低SES（HR，2.69；95%CI，2.48 - 2.92）或衰弱（HR，2.75；95%CI，2.58 - 2.93）分别增加了COPD风险；SES与COPD之间11.80%的关联由衰弱介导。此外，低SES和衰弱与COPD发病率存在统计学显著的相加交互作用（交互导致的相对风险，3.591；95%CI，2.189 - 4.992；交互导致的归因比例，0.433；95%CI，0.276 - 0.589）。与高SES的健壮个体相比，低SES的衰弱个体患COPD的风险最高（HR，7.85；95%CI，6.96 - 8.86）。