Racial Differences in Quality of Life in Patients With COPD
Racial Differences in Quality of Life in Patients With COPD
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DOI：
10.1378/chest.10-2869
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发表时间：
2011-11-01
期刊：
影响因子：
9.6
通讯作者：
Foreman, Marilyn G.
中科院分区：
文献类型：
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作者：
Han, MeiLan K.;Curran-Everett, Douglas;Foreman, Marilyn G.
背景资料：尽管COPD与显著的健康相关生活质量（HRQL）损害相关，但对COPD患者影响HRQL的因素尚未充分了解，尤其是在非裔美国人中。我们假设COPD患者的HRQL因种族而异，并试图确定与这些差异相关的因素。我们分析了224名非洲裔美国人和1名，049例白人COPD受试者入组COPDGene（COPD的遗传流行病学）疾病分类为GOLD的研究使用圣乔治呼吸问卷（SGRQ）比较（慢性阻塞性肺疾病全球倡议）I至W期HRQL和症状和改良的医学研究理事会呼吸困难（MMRC）量表。我们构建了一个混合效应的线性回归模型SGRQ score.Results：非裔美国人更年轻，报告较少包年的吸烟，更多的当前吸烟，并获得较少的教育比高加索人; MMRC得分较高（P = 0.02），SGRQ得分（平均得分差异，8.4; P <0.001）。在调整年龄、性别和吸烟包-年等因素后的SGRQ总评分的一般线性模型中，前一年未报告COPD急性加重的非裔美国人和白人的SGRQ总评分相似。然而，对于急性加重受试者，非裔美国人的SGRQ总分增加的相对程度大于白人（每次急性加重1.89分，P = .006）。对于住院急性发作，非裔美国人对SGRQ总分的影响也更大（4.19分，P = .04）。此外，有较大比例的非裔美国人报告在前一年至少有一次需要住院治疗的恶化（32%对16%，P < .001）。在考虑影响生活质量的其他变量的分析中，非裔美国人和白人COPD患者的HRQL相似，但发生急性加重的非裔美国人的HRQL更差，尤其是住院恶化。
Background: Although COPD is associated with significant health-related quality-of-life (HRQL) impairment, factors influencing HRQL in patients with COPD are not well understood, particularly in African Americans. We hypothesized that HRQL in COPD differs by race and sought to identify factors associated with those differences.Methods: We analyzed 224 African American and 1,049 Caucasian subjects with COPD enrolled in the COPDGene (Genetic Epidemiology of COPD) Study whose conditions were classified as GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to W HRQL and symptoms were compared using the St. George Respiratory Questionnaire (SGRQ) and the modified Medical Research Council Dyspnea (MMRC) scale. We constructed a mixed-effects linear regression model for SGRQ score.Results: African Americans were younger and reported fewer pack-years of smoking, more current smoking, and less attained education than Caucasians; MMRC scores were higher (P = .02) as were SGRQ scores (mean score difference, 8.4; P < .001). In a general linear model of SGRQ total score after adjusting for factors such as age, sex, and pack-years of smoking, SGRQ total score was similar for African Americans and Caucasians who reported no COPD exacerbations in the prior year. However, for subjects with exacerbations, SGRQ total score was increased to a greater relative extent for African Americans than for Caucasians (1.89 points for each exacerbation, P = .006). For hospitalized exacerbations, the effect on SGRQ total score also was greater for African Americans (4.19 points, P = .04). Furthermore, a larger percentage of African Americans reported having had at least one exacerbation that required hospitalization in the prior year (32% vs 16%, P < .001).Conclusion: In analyses that account for other variables that affect quality of life, HRQL is similar for African Americans and Caucasians with COPD without exacerbations but worse for African Americans who experience exacerbations, particularly hospitalized exacerbations.