Relationship between socioeconomic status and disease severity in cystic fibrosis
Relationship between socioeconomic status and disease severity in cystic fibrosis
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DOI：
10.1016/s0022-3476(98)70442-1
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发表时间：
1998-02-01
影响因子：
5.1
通讯作者：
Margolis, PA
中科院分区：
文献类型：
--
作者：
Schechter, MS;Margolis, PA
目的：本研究旨在评估社会经济地位处于不利地位的囊性纤维化 (CF) 患者是否与高收入患者有不同的结果，医疗补助保险覆盖范围被用作低家庭收入的代表。研究设计：对 1994 年在北卡罗来纳大学 CF 中心看到的一组年龄小于 21 岁的患者进行横断面分析。结果：医疗补助诊断中位年龄的差异（132 天）和非医疗补助（177 天）患者无统计学意义（p = 0.17）。医疗补助患者全年预测 1 秒用力呼气量的平均最大百分比比非医疗补助组低 11.6% (p = 0.01)；这种差异在不同年龄阶段都是恒定的。享受医疗补助的患者当年平均入院人数增加 0.8 次 (p < 0.01)，住院天数平均增加 8.8 天 (Cos 0.01)，但接受的门诊静脉治疗量相同。年内，他们到该中心就诊的次数也多了 1.20 次 (p = 0.02)。结论：患有 CF 的医疗补助患者具有莫尔斯肺功能，并且比条件较好的患者需要更多的肺部病情加重治疗。这种差异似乎在生命早期就开始了，不会随着年龄的增长而增加，也不能用门诊专业护理的机会不足或诊断延迟来解释。其他解释，例如缺乏初级保健机会、不遵守规定的治疗方案或更多地接触污染物（例如环境烟草烟雾）都是推测性的。
Objective: This study tvas carried out to evaluate whether patients with cystic fibrosis (CF) who are socioeconomically disadvantaged, have a different outcome than higher-income patients, Medicaid insurance coverage was used as a proxy of low family income.Study design: A cross-sectional analysis sas performed on a group of patients younger than 21 years of age seen at the University of North Carolina CF Center in 1994.Results: The difference in median age al diagnosis for Medicaid (132 days) and non-Medicaid (177 days) patients uas not statistically significant (p = 0.17). Medicaid patients' mean maximum percent predicted forced expiratory volume in 1 second for the year was 11.6% less than that of the non-Medicaid group (p = 0.01); this difference was constant across age. Medicaid patients averaged 0.8 more admissions for the year (p < 0.01) and 8.8 more days Cos 0.01) in the hospital but received the same amount of outpatient intravenous therapy. They also had 1.20 more outpatient visits to the center during the year (p = 0.02).Conclusions: Medicaid patients with CF have morse lung function and require more treatment for pulmonary exacerbations than their more advantaged counterparts. This difference appears to begin early in life, does not increase with age, and is not explained by inadequate access to outpatient specialty care or delayed diagnosis. Other explanations such as inadequate access to primary care, poor adherence to prescribed regimens, or greater exposure to pollutants (e.g., environmental tobacco smoke) are speculative.