Association of socioeconomic status with respiratory mortality and hospitalisations in COPD: a nationwide cohort study.

IF 3.4 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2025-09-26 DOI:10.1136/bmjresp-2024-003128

Hyewon Lee, Bo Young Lee, Jiyun Jung, Jinwoo Seok, Jung-Hyun Kim, So-My Koo, Hee-Young Yoon

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Abstract

Background: Socioeconomic status (SES) and air pollution are independently associated with adverse outcomes in patients with chronic obstructive pulmonary disease (COPD). This study investigated the association of SES with respiratory mortality and hospitalisation, while adjusting for air pollution.

Methods: This retrospective cohort study analysed the individual-level and area-level SES indicators, as well as long-term air pollution exposure, associated with COPD in the Korean National Health Insurance Service-National Sample Cohort. The associations of SES with respiratory mortality and hospitalisation were evaluated using Cox proportional hazards models after adjusting for clinical factors and air pollution.

Results: Among 12 820 patients (mean age: 63.5 years, 47.2% male), 115 (0.9%) and 1870 (14.6%) experienced respiratory mortality and respiratory-related hospitalisation, respectively. Self-employed members had higher mortality risks than self-employed heads (HR=2.397, 95% CI=1.044 to 5.501). Regions with older adults constituting 20-50% of the population exhibited reduced mortality risks (HR=0.516, 95% CI 0.269 to 0.991). The area-level covariates significant in the clinically adjusted models lost significance after adjusting for air pollution. Income level (HR=0.979, 95% CI 0.965 to 0.993) exhibited a negative association with respiratory hospitalisation risks. Suburban (HR=1.321, 95% CI 1.141 to 1.530) and rural (HR=1.398, 95% CI 1.202 to 1.626) residential status was associated with a higher hospitalisation risk. A higher older-adult population was positively associated with hospitalisation risk (HR=1.023, 95% CI 1.014 to 1.033). Higher education level and gross regional domestic product quartiles exhibited reduced hospitalisation risk.

Conclusions: The associations between SES and mortality and hospitalisation risks remained attenuated and persistent, respectively, after adjusting for air pollution.

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社会经济地位与慢性阻塞性肺病呼吸系统死亡率和住院率的关系：一项全国性队列研究

背景：社会经济地位（SES）和空气污染与慢性阻塞性肺疾病（COPD）患者的不良结局独立相关。本研究调查了SES与呼吸系统死亡率和住院率的关系，同时调整了空气污染。方法：本回顾性队列研究分析了韩国国民健康保险服务国家样本队列中与COPD相关的个人水平和地区水平SES指标以及长期空气污染暴露。在调整临床因素和空气污染后，使用Cox比例风险模型评估SES与呼吸系统死亡率和住院率的关系。结果：12820例患者（平均年龄63.5岁，男性47.2%）中，分别有115例（0.9%）和1870例（14.6%）出现呼吸系统死亡和呼吸相关住院。个体经营者死亡风险高于个体经营者（HR=2.397, 95% CI=1.044 ~ 5.501）。老年人占人口20-50%的地区显示出较低的死亡风险（HR=0.516, 95% CI 0.269 ~ 0.991）。在临床校正模型中显著的区域水平协变量在校正空气污染后失去了显著性。收入水平（HR=0.979, 95% CI 0.965 ~ 0.993）与呼吸系统住院风险呈负相关。郊区（HR=1.321, 95% CI 1.141至1.530）和农村（HR=1.398, 95% CI 1.202至1.626）居住状况与较高的住院风险相关。较高的老年人口与住院风险呈正相关（HR=1.023, 95% CI 1.014 ~ 1.033）。高等教育水平和地区国内生产总值四分位数显示住院风险降低。结论：在调整空气污染因素后，SES与死亡率和住院风险之间的关联仍然减弱和持续存在。

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.