对于COPD患者因任何原因死亡的社会人口和地理风险因素
Camille Robichaux1, Jordan Aron2, Chris H Wendt1,3
1Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.
概括
慢性阻塞性肺病 (COPD) 的死亡率在城市地区和贫困社区更高. 考虑到社会经济因素,种族和并发症,COPD死亡率的差异减少了.
科学领域:
- 肺部医学 肺部医学
- 流行病学 流行病学
- 健康的社会决定因素
背景情况:
- 慢性阻塞性肺病 (COPD) 是全球死亡的重要原因之一.
- 识别COPD死亡率的个人和社区风险因素对于改善患者的治疗结果至关重要.
- 很少有基于人口的研究检查了影响COPD死亡率的个人和社区层面因素.
研究的目的:
- 研究COPD患者个体人口统计,社区社会经济地位和全因死亡率之间的关联.
- 利用地理编码的患者级数据,全面分析COPD死亡风险因素.
主要方法:
- 一个全国代表性的追溯队列分析,来自退伍军人卫生管理局 (Veteran Health Administration) 的超过100万名COPD患者 (2016-2019).
- 包括人口特征,并发症和地理编码的住所地址.
- 基于地理编码地址的面积剥夺指数和农村地区的分类.
- 后勤回归模型用于评估与年龄调整的全因死亡率的关联.
主要成果:
- 到2021年1月,该队列中33.4%的COPD患者死亡.
- 在经年龄调整的模型中,较高的死亡率与更多的并发病,黑人/非裔美国人种族以及更大的社区劣势有关.
- 女性性别,亚洲种族和生活在农村地区与较低的死亡率相关.
- 在对共变量进行调整后,黑人/非裔美国人种族与死亡率之间的关联不再显著.
结论:
- 在COPD患者中,所有原因的死亡率在居住在贫困城市社区的人群中不成比例地高,这突显了健康的社会决定因素的影响.
- 虽然黑人种族的年龄调整后死亡率较高,但在控制人口,社会经济和临床因素后,这种关联减少了.
- 需要进一步的研究,以了解这些差异背后的机制,并制定有针对性的干预措施.
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