The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States
The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States
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DOI：
10.1164/ajrccm.163.6.9912100
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发表时间：
2001-05-01
影响因子：
24.7
通讯作者：
Fitzsimmons, SC
中科院分区：
文献类型：
--
作者：
Schechter, MS;Shelton, BJ;Fitzsimmons, SC
囊性纤维化（CF）的临床病程存在相当大的变异性。虽然目前尚未确定的修饰基因可能解释这种异质性的一些，其他因素可能是促成。社会经济状况（SES）是许多慢性多基因疾病健康状况的重要预测因素，但其在CF中的作用尚未得到系统评价。我们使用1986年至1994年国家囊性纤维化基金会患者登记处（NCFPR）的数据对美国儿童CF患者进行了历史队列分析，并使用医疗补助状态作为低SES的代表。与未接受医疗补助的患者相比，医疗补助患者的调整后死亡风险高3.65倍（95%置信区间[CI]：3.03至4.40）。存活的医疗补助患者的FEV1预测百分比降低了9.1%（95%CI：6.9至11.2）。与非医疗补助患者相比，医疗补助患者体重低于第5百分位数的可能性高2.19倍（95% CI：1.91至2.51），身高低于第5百分位数的可能性高2.22倍（95% CI：1.95至2.52）。医疗补助患者需要治疗肺部急性加重的可能性是其他患者的1.60倍（95% CI：1.29至1.98）。医疗补助和非医疗补助患者的门诊就诊次数没有差异。我们的结论是，低SES与CF儿童的预后显着较差。获得专业保健的障碍似乎不能解释这种差异。进一步的研究表明，以确定哪些不利的环境因素可能聚集在CF患者的低SES，导致更糟糕的结果。
There is considerable variability in the clinical course of disease in cystic fibrosis (CF). Although currently unidentified modifier genes might explain some of this heterogeneity, other factors are probably contributory. Socioeconomic status (SES) is an important predictor of health status in many chronic polygenic diseases, but its role in CF has not been systematically evaluated. We performed a historical cohort analysis of pediatric CF patients in the United States using National Cystic Fibrosis Foundation Patient Registry (NCFPR) data for 1986 to 1994, and used Medicaid status as a proxy for low SES. The adjusted risk of death was 3.65 times higher (95% confidence interval [CI]: 3.03 to 4.40) for Medicaid patients than for those not receiving Medicaid. The percent predicted FEV1 of surviving Medicaid patients was less by 9.1% (95% CI: 6.9 to 11.2). Medicaid patients were 2.19 times more likely to be below the 5th percentile for weight (95% CI: 1.91 to 2.51) and 2.22 times more likely to be below the 5th percentile for height (95% CI: 1.95 to 2.52) than were non-Medicaid patients. Medicaid patients were 1.60 times more likely to require treatment for a pulmonary exacerbation (95% CI: 1.29 to 1.98). There was no difference in the number of outpatient clinic visits for Medicaid and non-Medicaid patients. We conclude that low SES is associated with significantly poorer outcomes in children with CF. Barriers in access to specialty health care do not seem to explain this difference. Further study is indicated to determine what adverse environmental factors might cluster in CF patients of low SES to cause worse outcomes.