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AM J RESP CRIT CARE：社会经济地位与肺动脉高压全因死亡率呈负相关

2012-12-19 AM J RESP CRIT CARE AM J RESP CRIT CARE

肺动脉高压经济
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　　由同济大学附属上海市肺科医院荆志成教授等进行的一项前瞻性队列研究结果提示，肺动脉高压患者社会经济地位越低，其发生死亡和临床恶化事件的风险越高，且此风险独立于患者基线临床特征、血流动力学以及药物治疗的方案。文献于12月6日在线发表于《美国呼吸与危重症杂志》（Am J Respir Crit Care Med）。　　 　　研究简介 　　该前瞻性


　　由同济大学附属上海市肺科医院荆志成教授等进行的一项前瞻性队列研究结果提示，肺动脉高压患者社会经济地位越低，其发生死亡和临床恶化事件的风险越高，且此风险独立于患者基线临床特征、血流动力学以及药物治疗的方案。文献于12月6日在线发表于《美国呼吸与危重症杂志》（Am J Respir Crit Care Med）。　　

　　研究简介

　　该前瞻性队列研究共纳入自2007年1月至2011年6月就诊的262例特发性肺动脉高压患者，随访至2011年11月。基于患者的教育水平、家庭年收入及医疗支出比例对其进行社会经济地位评分。研究主要终点为患者的全因死亡率。

　　结果显示，社会经济地位较低者未校正的死亡率较高，随着社会经济地位的升高（分为低、中、高3组），3年生存率分别为50.1%、70.8%及86.0%（P<0.001）。在校正临床特征、血流动力学及治疗方式后，死亡HR为2.98（P=0.006）。

　　该结果提示，较低的社会经济地位与特发性肺动脉高压的高死亡风险密切相关。这种相关性独立于临床特点、血流动力学及治疗方式。将健康差异与较低的社会经济地位相关联将有益于改善肺动脉高压患者的转归。

　　

　　■研究者说

　　社会经济地位影响患者生存率

　　同济大学附属上海市肺科医院 荆志成

　　肺动脉高压是一种致死性疾病，临床医生应明确认识较低社会经济地位患者存在的一些危险因素，如活动和行为，并通过有效的二级预防措施监督和指导患者降低相关风险。该研究是国际上首次在此领域进行科学研究。

　　未来的研究应着力于探讨社会经济地位影响肺动脉高压患者预后的机制，明确社会和环境的危险因素，以期通过干预这些危险因素降低不同社会经济地位患者之间的预后差异。

　　本研究结果亦表明，此项危险因素并不特异存在于发展中国家，在发达国家也同样存在患者之间的社会经济地位差异、包括受教育程度等都会成为固定影响患者预后的重要因素，探讨这些危险因素发生作用的内部机制，有望能成为改善患者预后的另一重要手段。

　　是否社会经济地位差异也是其他严重心肺疾病预后恶劣的危险因素，这也是本研究提出的一个深刻而严肃的问题，值得临床医生、政府部门所思考。研究提示我们需要在慢性心力衰竭、阻塞性肺疾病及心肌病等领域广泛开展类似研究，以期这些研究能引起卫生行政管理部门的进一步重视，采取措施来改善这些严重心肺疾病患者因社会经济地位差异而带来的恶劣预后。

与肺动脉高压相关的拓展阅读：



Rationale
Lower socioeconomic status (SES) confers a heightened risk of common cardiovascular and pulmonary diseases and increased mortality. The association of SES with outcomes in patients with pulmonary arterial hypertension (PAH) is less clear.
Objectives
To determine the association between SES and outcomes in PAH patients.
Methods
We performed a prospective cohort study at a national referral center for PAH patients in China. Two hundred and sixty-two consecutive incident patients aged 18 to 65 years with a diagnosis of idiopathic PAH were recruited between January 2007 and June 2011 and followed-up until November 2011. The primary endpoint was all-cause mortality. A SES score for each patient was derived from their educational level, annual household income, occupation, and medical reimbursement rate.
Measurements and Main Results
Patients with a lower SES had higher unadjusted mortality rates with 3-year survival estimates of 50.1%, 70.8%, and 86.0% in increasing tertiles of SES (P for trend <0.001). After adjustment for clinical features, hemodynamics, and type of PAH treatment, the hazard ratios for death were 2.98 (95% confidence interval [CI], 1.51 to 5.89) in the lowest tertile of SES, and 1.80 (95% CI, 0.89 to 3.63) in the middle tertile of SES compared with the upper tertile (P for trend = 0.006).
Conclusions
A lower SES is strongly associated with a higher risk of death in idiopathic PAH. This association was independent of clinical characteristics, hemodynamics, and treatment. Addressing the health disparities associated with a lower SES may improve the outcomes of patients with PAH.    

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    2013-01-28 jklm09

    #动脉高压#

    0

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    2013-03-10 s_pl2008

    #经济地位#

    0

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    2013-03-28 ms1260584454294838

    #社会经济#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1925088, encodeId=a71d19250886c, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Jan 28 12:55:00 CST 2013, time=2013-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805495, encodeId=811a18054958d, content=<a href='/topic/show?id=cc8ae8341fc' target=_blank style='color:#2F92EE;'>#经济地位#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78341, encryptionId=cc8ae8341fc, topicName=经济地位)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Mar 10 08:55:00 CST 2013, time=2013-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924448, encodeId=70eb19244488c, content=<a href='/topic/show?id=a7f2e3997c4' target=_blank style='color:#2F92EE;'>#社会经济#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73997, encryptionId=a7f2e3997c4, topicName=社会经济)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Thu Mar 28 07:55:00 CST 2013, time=2013-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1251446, encodeId=f9f712514462c, content=<a href='/topic/show?id=874529332ba' target=_blank style='color:#2F92EE;'>#全因死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29332, encryptionId=874529332ba, topicName=全因死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457144, encodeId=7bb2145e14486, content=<a href='/topic/show?id=94f5e400123' target=_blank style='color:#2F92EE;'>#社会经济地位#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74001, encryptionId=94f5e400123, topicName=社会经济地位)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6025850709, createdName=chenwq10, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1573198, encodeId=454715e319856, content=<a href='/topic/show?id=34009226531' target=_blank style='color:#2F92EE;'>#负相关#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92265, encryptionId=34009226531, topicName=负相关)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c2115837741, createdName=hmwwww, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1616578, encodeId=05d616165e872, content=<a href='/topic/show?id=e660e3936c0' target=_blank style='color:#2F92EE;'>#社会#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73936, encryptionId=e660e3936c0, topicName=社会)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6de19781024, createdName=ms705947299214030, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=)]
    2012-12-21 lvliquan

    #全因死亡率#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1925088, encodeId=a71d19250886c, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Jan 28 12:55:00 CST 2013, time=2013-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805495, encodeId=811a18054958d, content=<a href='/topic/show?id=cc8ae8341fc' target=_blank style='color:#2F92EE;'>#经济地位#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78341, encryptionId=cc8ae8341fc, topicName=经济地位)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Mar 10 08:55:00 CST 2013, time=2013-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924448, encodeId=70eb19244488c, content=<a href='/topic/show?id=a7f2e3997c4' target=_blank style='color:#2F92EE;'>#社会经济#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73997, encryptionId=a7f2e3997c4, topicName=社会经济)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Thu Mar 28 07:55:00 CST 2013, time=2013-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1251446, encodeId=f9f712514462c, content=<a href='/topic/show?id=874529332ba' target=_blank style='color:#2F92EE;'>#全因死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29332, encryptionId=874529332ba, topicName=全因死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457144, encodeId=7bb2145e14486, content=<a href='/topic/show?id=94f5e400123' target=_blank style='color:#2F92EE;'>#社会经济地位#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74001, encryptionId=94f5e400123, topicName=社会经济地位)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6025850709, createdName=chenwq10, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1573198, encodeId=454715e319856, content=<a href='/topic/show?id=34009226531' target=_blank style='color:#2F92EE;'>#负相关#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92265, encryptionId=34009226531, topicName=负相关)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c2115837741, createdName=hmwwww, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1616578, encodeId=05d616165e872, content=<a href='/topic/show?id=e660e3936c0' target=_blank style='color:#2F92EE;'>#社会#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73936, encryptionId=e660e3936c0, topicName=社会)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6de19781024, createdName=ms705947299214030, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=)]
    2012-12-21 chenwq10

    #社会经济地位#

    0

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    2012-12-21 hmwwww

    #负相关#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1925088, encodeId=a71d19250886c, content=<a href='/topic/show?id=26d633354c9' target=_blank style='color:#2F92EE;'>#动脉高压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33354, encryptionId=26d633354c9, topicName=动脉高压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Mon Jan 28 12:55:00 CST 2013, time=2013-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1805495, encodeId=811a18054958d, content=<a href='/topic/show?id=cc8ae8341fc' target=_blank style='color:#2F92EE;'>#经济地位#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78341, encryptionId=cc8ae8341fc, topicName=经济地位)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=71f1477, createdName=s_pl2008, createdTime=Sun Mar 10 08:55:00 CST 2013, time=2013-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1924448, encodeId=70eb19244488c, content=<a href='/topic/show?id=a7f2e3997c4' target=_blank style='color:#2F92EE;'>#社会经济#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73997, encryptionId=a7f2e3997c4, topicName=社会经济)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/D2FD7704B41C9E22364B1E54ABB223BB/100, createdBy=1df22500220, createdName=ms1260584454294838, createdTime=Thu Mar 28 07:55:00 CST 2013, time=2013-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1251446, encodeId=f9f712514462c, content=<a href='/topic/show?id=874529332ba' target=_blank style='color:#2F92EE;'>#全因死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29332, encryptionId=874529332ba, topicName=全因死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=796422, createdName=lvliquan, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1457144, encodeId=7bb2145e14486, content=<a href='/topic/show?id=94f5e400123' target=_blank style='color:#2F92EE;'>#社会经济地位#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74001, encryptionId=94f5e400123, topicName=社会经济地位)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6025850709, createdName=chenwq10, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1573198, encodeId=454715e319856, content=<a href='/topic/show?id=34009226531' target=_blank style='color:#2F92EE;'>#负相关#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92265, encryptionId=34009226531, topicName=负相关)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c2115837741, createdName=hmwwww, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1616578, encodeId=05d616165e872, content=<a href='/topic/show?id=e660e3936c0' target=_blank style='color:#2F92EE;'>#社会#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73936, encryptionId=e660e3936c0, topicName=社会)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6de19781024, createdName=ms705947299214030, createdTime=Fri Dec 21 02:55:00 CST 2012, time=2012-12-21, status=1, ipAttribution=)]
    2012-12-21 ms705947299214030

    #社会#

    0

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