Trisha M Parekh1, Andrea L Cherrington2, Smita Bhatia3, Bulent Turan4, Siddharth B Patel5, Young-Il Kim1, Janet M Turan6, Mark T Dransfield1,7. 1. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham. 2. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham. 3. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham. 4. Department of Psychology, University of Alabama at Birmingham. 5. Lung Health Center, University of Alabama at Birmingham. 6. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham. 7. Birmingham VA Medical Center, Birmingham, Alabama.
Abstract
INTRODUCTION: Low-income chronic obstructive pulmonary disease (COPD) individuals are known to have higher rates of COPD-related hospitalizations and readmissions. Levels of psychological stress are also higher in low-income populations and may be associated with acute care use. We sought to: (1) determine the association between stress and acute care use in COPD, (2) evaluate the social determinants of health (SDH) in low and high stress individuals, and (3) determine the association between low income and high stress with acute care use. MATERIALS AND METHODS: Using results from a survey-based study of individuals with COPD at the University of Alabama (UAB), we used multivariable regression modeling to evaluate the association of high stress with acute care use (COPD-related emergency department [ED] visits or hospitalizations). We then compared SDH between low and high stress groups and evaluated the association of low income + high stress with acute care use in a secondary model. RESULTS: We included 126 individuals in our study. The high stress group was more likely to be < 65 years old and female. No differences in race, smoking, years of smoking, body mass index, dyspnea, or lung function (forced expiratory volume in 1 second [FEV1]%) by stress group were observed. The high stress group had a 2.5-fold increased adjusted odds of acute care use (adjusted odds ratio [AOR]95% confidence interval [CI], 2.51, 1.06-5.98) compared to the low stress group, while the low-income + high stress group had a 4-fold increased adjusted odds of acute care use (AOR, 95% CI, 4.38, 1.25-15-45) compared to high-income + low-stress group. CONCLUSIONS: Acute care use and stress are associated in COPD. These associations are more pronounced in the low-income + high stress population who disproportionately contribute to health care utilization and frequently lack the resources needed to cope with stress. JCOPDF
INTRODUCTION: Low-income chronic obstructive pulmonary disease (COPD) individuals are known to have higher rates of COPD-related hospitalizations and readmissions. Levels of psychological stress are also higher in low-income populations and may be associated with acute care use. We sought to: (1) determine the association between stress and acute care use in COPD, (2) evaluate the social determinants of health (SDH) in low and high stress individuals, and (3) determine the association between low income and high stress with acute care use. MATERIALS AND METHODS: Using results from a survey-based study of individuals with COPD at the University of Alabama (UAB), we used multivariable regression modeling to evaluate the association of high stress with acute care use (COPD-related emergency department [ED] visits or hospitalizations). We then compared SDH between low and high stress groups and evaluated the association of low income + high stress with acute care use in a secondary model. RESULTS: We included 126 individuals in our study. The high stress group was more likely to be < 65 years old and female. No differences in race, smoking, years of smoking, body mass index, dyspnea, or lung function (forced expiratory volume in 1 second [FEV1]%) by stress group were observed. The high stress group had a 2.5-fold increased adjusted odds of acute care use (adjusted odds ratio [AOR]95% confidence interval [CI], 2.51, 1.06-5.98) compared to the low stress group, while the low-income + high stress group had a 4-fold increased adjusted odds of acute care use (AOR, 95% CI, 4.38, 1.25-15-45) compared to high-income + low-stress group. CONCLUSIONS: Acute care use and stress are associated in COPD. These associations are more pronounced in the low-income + high stress population who disproportionately contribute to health care utilization and frequently lack the resources needed to cope with stress. JCOPDF
Authors: Sheldon Cohen; Denise Janicki-Deverts; William J Doyle; Gregory E Miller; Ellen Frank; Bruce S Rabin; Ronald B Turner Journal: Proc Natl Acad Sci U S A Date: 2012-04-02 Impact factor: 11.205
Authors: Laura E Leggett; Rachel G Khadaroo; Jayna Holroyd-Leduc; Diane L Lorenzetti; Heather Hanson; Adrian Wagg; Raj Padwal; Fiona Clement Journal: Medicine (Baltimore) Date: 2016-03 Impact factor: 1.889
Authors: Trisha M Parekh; Chengyi Wu; Leslie A McClure; Virginia J Howard; Mary Cushman; Angela M Malek; Kathleen F Harrington; Andrea L Cherrington; Mark T Dransfield; Smita Bhatia Journal: BMJ Open Date: 2019-05-10 Impact factor: 2.692