The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study
The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study
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DOI：
10.1186/s12931-019-1255-z
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发表时间：
2019-12-21
影响因子：
5.8
通讯作者：
Williams, Sian
中科院分区：
文献类型：
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作者：
Brakema, Evelyn A.;Tabyshova, Aizhamal;Williams, Sian
由于儿童早期的不利条件和室内/室外空气污染，低资源环境受到慢性肺病的沉重负担。然而，在这些环境中，呼吸道疾病的社会经济影响的数据基本上是缺乏的。因此，我们旨在估计地球仪不同低资源环境中慢性肺病相关的社会经济负担。为了告知政府和卫生政策，我们专注于工作效率和活动障碍及其可改变的临床和环境风险因素。方法：我们在乌干达、越南、吉尔吉斯斯坦和希腊进行了一项横断面观察性FRESH AIR研究。我们使用经肺量计诊断的COPD和/或哮喘患者（总N = 1040）的有效问卷评估了慢性肺病相关的社会经济负担。使用多变量线性回归模型研究了更高负担的预测因素，包括人口统计学（例如年龄，性别），健康参数（呼吸困难，合并症）和慢性肺部疾病的风险因素（吸烟，固体燃料使用）。我们在每个国家应用了相同的模型，随后进行了荟萃分析。结果就业患者报告的中位[IQR]总体工作障碍是由于慢性肺部疾病的30% [1.8-51.7]和生产力下降（出勤率）的20.0% [0.0-40.0]。值得注意的是，工作时间错过（缺勤）为0.0% [0.0-16.7]。总人群报告40.0% [20.0-60.0]的日常活动受损。呼吸困难严重程度（MRC-量表）（B = 8.92，95%CI = 7.47-10.36）、吸烟（B = 5.97，95%CI = 1.73-10.22）和固体燃料使用（B = 3.94，95%CI = 0.56-7.31）是潜在的可改变的损伤风险因素。结论：在低资源环境中，慢性肺病相关的缺勤率相对较低，相比之下，大量的出勤率和活动障碍。可能是由于缺乏社会保障制度，相对较少的人以生产力下降为代价休假。呼吸困难（MRC评分）、吸烟和固体燃料使用是较高损害的潜在可修改预测因素。结果证明，卫生政策制定者和卫生保健工作者在低资源环境中提高了对肺部疾病的认识、预防行动和临床管理。
Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8-51.7] and decreased productivity (presenteeism) of 20.0% [0.0-40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0-16.7]. The total population reported 40.0% [20.0-60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47-10.36), smoking (B = 5.97, 95%CI = 1.73-10.22), and solid fuel use (B = 3.94, 95%CI = 0.56-7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.