Kyoung Hee Cho1, Chung Mo Nam2, Eun Jung Lee3, Young Choi1, Ki-Bong Yoo4, Seon-Heui Lee5, Eun-Cheol Park6. 1. Department of Public Health, Graduate School, Yonsei University, South Korea; Institute of Health Services Research, College of Medicine, Yonsei University, South Korea. 2. Institute of Health Services Research, College of Medicine, Yonsei University, South Korea; Department of Biostatistics, College of Medicine, Yonsei University, South Korea. 3. Graduate School of Social Welfare, Yonsei University, South Korea. 4. Department of Healthcare Management, Eulji University, South Korea. 5. Department of Nursing Science, College of Nursing, Gachon University, South Korea. 6. Institute of Health Services Research, College of Medicine, Yonsei University, South Korea; Department of Preventive Medicine, College of Medicine, Yonsei University, South Korea. Electronic address: ECPARK@yuhs.ac.
Abstract
BACKGROUND: Numerous previous studies have shown that individual socioeconomic status (SES) is associated with mortality in patients with chronic obstructive pulmonary disease (COPD), but few empirical studies have evaluated the effects of individual SES and neighborhood deprivation on mortality in COPD patients. METHODS: We performed a prospective cohort study to examine the effect of socioeconomic disparity on all-cause mortality in newly diagnosed COPD patients in a setting with universal health care coverage. We used representative population-based nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). We included patients who were at least 40 years old and newly diagnosed with COPD (N = 9275). To analyze the data, we utilized a frailty model and Cox's proportional hazard regression. RESULTS: A total of 1849 (19.9%) of the 9275 eligible participants died during the study period. Compared to high-income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for middle-income COPD patients who lived in advantaged and disadvantaged neighborhoods was 1.22 (95% CI, 1.03-1.43) and 1.36 (95% CI, 1.15-1.60), respectively. For low-income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than for patients who lived in advantaged neighborhoods (HR, 1.43; 95% CI, 1.17-1.74 vs. HR, 1.36; 95% CI, 1.11-1.66). There was no difference in the adjusted HRs for high-income patients who lived in advantaged and disadvantaged neighborhoods (HR, 1.01; 95% CI, 0.84-1.22). CONCLUSIONS: Socioeconomic disparity contributes to all-cause mortality in COPD patients and neighborhood deprivation exacerbates the effect of individual SES on all-cause mortality in COPD patients.
BACKGROUND: Numerous previous studies have shown that individual socioeconomic status (SES) is associated with mortality in patients with chronic obstructive pulmonary disease (COPD), but few empirical studies have evaluated the effects of individual SES and neighborhood deprivation on mortality in COPDpatients. METHODS: We performed a prospective cohort study to examine the effect of socioeconomic disparity on all-cause mortality in newly diagnosed COPDpatients in a setting with universal health care coverage. We used representative population-based nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). We included patients who were at least 40 years old and newly diagnosed with COPD (N = 9275). To analyze the data, we utilized a frailty model and Cox's proportional hazard regression. RESULTS: A total of 1849 (19.9%) of the 9275 eligible participants died during the study period. Compared to high-income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for middle-income COPDpatients who lived in advantaged and disadvantaged neighborhoods was 1.22 (95% CI, 1.03-1.43) and 1.36 (95% CI, 1.15-1.60), respectively. For low-income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than for patients who lived in advantaged neighborhoods (HR, 1.43; 95% CI, 1.17-1.74 vs. HR, 1.36; 95% CI, 1.11-1.66). There was no difference in the adjusted HRs for high-income patients who lived in advantaged and disadvantaged neighborhoods (HR, 1.01; 95% CI, 0.84-1.22). CONCLUSIONS: Socioeconomic disparity contributes to all-cause mortality in COPDpatients and neighborhood deprivation exacerbates the effect of individual SES on all-cause mortality in COPDpatients.
Authors: Maciej Polak; Agnieszka Genowska; Krystyna Szafraniec; Justyna Fryc; Jacek Jamiołkowski; Andrzej Pająk Journal: Int J Environ Res Public Health Date: 2019-05-21 Impact factor: 3.390
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