The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population: a longitudinal study.
The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population: a longitudinal study.
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DOI：
10.1016/s2213-2600(13)70002-x
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发表时间：
2013-04
影响因子：
76.2
通讯作者：
Whitehead, Margaret
中科院分区：
文献类型：
--
作者：
Taylor-Robinson, David C.;Smyth, Rosalind L.;Diggle, Peter J.;Whitehead, Margaret
贫穷的社会经济环境与囊性纤维化的不良结局有关。我们评估了社会剥夺和个人的临床和医疗保健结果之间是否存在关系。我们对英国40岁以下囊性纤维化人群进行了纵向登记研究（8055人，49337个体重观察结果，最常见的结果，1996年1月1日至2009年12月31日）。 我们评估了体重、身高、体重指数、1秒用力呼气量预测百分比（%FEV1）、铜绿假单胞菌定植风险和主要囊性纤维化治疗方式的使用。我们使用混合效应模型来评估小面积剥夺与临床和医疗保健结果之间的关联，并对临床重要协变量进行调整。我们给出连续的结果作为平均差异，二元结果作为比值比，比较剥夺五分位数的极端情况。与最贫困地区相比，来自最贫困地区的儿童体重较轻（标准差[SD]评分为-0.28，95% CI为-0.38至-0.18），（-0统计31，-0.40至-0.21），体重指数较低（-0统计13，-0.22至-0.04），更可能患有慢性铜绿假单胞菌感染（比值比1.89，95%CI 1.34至2.66），并且具有较低的%FEV1（-4统计学12个百分点，95%CI-5.01至-3.19）。这些不平等在生命的早期就很明显，此后并没有扩大。在人群水平上，调整疾病严重程度后，与最贫困的五分之一人群相比，最贫困的五分之一人群中的儿童更有可能接受静脉注射抗生素（比值比2.52，95%CI 1.92至3.17）和营养治疗（1.78，1.44至2.20）。来自最贫困地区的患者不太可能接受DNA酶或吸入性抗生素治疗。在英国，与来自富裕地区的儿童相比，来自贫困地区的囊性纤维化儿童的生长和肺功能较差，但这些不平等不会随着年龄的增长而扩大。临床医生在做出治疗决定时，会考虑剥夺状态以及疾病状态，这可能会减轻社会劣势的一些影响。英国医学研究理事会。
Poorer socioeconomic circumstances have been linked with worse outcomes in cystic fibrosis. We assessed whether a relation exists between social deprivation and individual's clinical and health-care outcomes. We did a longitudinal registry study of the UK cystic fibrosis population younger than 40 years (8055 people with 49 337 observations for weight, the most commonly collected outcome, between Jan 1, 1996, and Dec 31, 2009). We assessed data for weight, height, body-mass index, percent predicted forced expiratory volume in 1 s (%FEV1), risk of Pseudomonas aeruginosa colonisation, and the use of major cystic fibrosis treatment modalities. We used mixed effects models to assess the association between small-area deprivation and clinical and health-care outcomes, adjusting for clinically important covariates. We give continuous outcomes as mean differences, and binary outcomes as odds ratios, comparing extremes of deprivation quintile. Compared with the least deprived areas, children from the most deprived areas weighed less (standard deviation [SD] score −0·28, 95% CI −0·38 to −0·18), were shorter (–0·31, −0·40 to −0·21, and had a lower body-mass index (–0·13, −0·22 to −0·04), were more likely to have chronic P aeruginosa infection (odds ratio 1·89, 95% CI 1·34 to 2·66), and have a lower %FEV1 (–4·12 percentage points, 95% CI −5·01 to −3·19). These inequalities were apparent very early in life and did not widen thereafter. On a population level, after adjustment for disease severity, children in the most deprived quintile were more likely to receive intravenous antibiotics (odds ratio 2·52, 95% CI 1·92 to 3·17) and nutritional treatments (1·78, 1·44 to 2·20) compared with individuals in the least deprived quintile. Patients from the most disadvantaged areas were less likely to receive DNase or inhaled antibiotic treatment. In the UK, children with cystic fibrosis from more disadvantaged areas have worse growth and lung function compared with children from more affluent areas, but these inequalities do not widen with advancing age. Clinicians consider deprivation status, as well as disease status, when making decisions about treatments, and this might mitigate some effects of social disadvantage. Medical Research Council (UK).