Socioeconomic Status and Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background: Socioeconomic status (SES) is an important determinant of health and premature death. However, the impact of poor SES on the health status of patients with chronic obstructive pulmonary disease (COPD) has not been well determined. Objective: It was our aim to assess the impact of SES on the quality of life in COPD patients. Methods: This was a cross-sectional, observational, multicenter study. A total of 4,574 patients completed the EuroQol 5-dimension questionnaire (EQ-5D) and the Airways Questionnaire 20 (AQ20). SES was based on the subject’s occupation and educational level. Occupational categories were based on the major group classification of the International Standard Classification of Occupations. Results: The mean age of the population was 67.1 years and the mean forced expiratory volume was 43.4%. There was a gradient of impairment in health-related quality of life (HRQoL) according to the educational level, with significantly worse scores for the EQ-5D and the AQ20 for medium and low educational levels compared with high education (p < 0.001). Similarly, HRQoL was also significantly impaired in more unskilled workers, with a gradient of the AQ20 from 8.6 units (SD 4.8) in class I to 10.1 units (4.6) in class V (p < 0.001) and from 0.75 units in class I to 0.63 units in class V for the EQ-5D index, as well as from 62.9 units in class I to 55.6 units in class V for the EQ-5D visual analogue scale (p < 0.001 for all comparisons). These differences remained significant after controlling for covariates. Conclusions: Patients with a lower educational level and belonging to the unskilled professional groups had a poorer HRQoL. This is evident even in a country where access to health care services is universal and free.

Socioeconomic Status and Its Relationship to Chronic Respiratory Disease

“…Similarly, HRQoL was also significantly impaired in more unskilled workers www.journals.viamedica.pl than skilled workers. These differences remained significant after controlling for covariates [35].…”

“…A study from Spain by Miravitlles et al [35] determined that there was a gradient of impairment in HRQoL according to the educational level, as well as in more unskilled workers. HRQoL was measured using EQ-5D and AQ20 questionnaires that assessed patient reported perception of "current health", the five dimensions of mobility, self-care, usual activities, pain/discomfort, anxiety/depression and finally respiratory HRQoL in COPD.…”

Calidad de vida relacionada con la salud en pacientes con enfermedad pulmonar obstructiva crónica en Hospital Universitario de Santander

“…La edad promedio fue: 65,5(±10,3) años y la distribución por género mostró la presencia de 24(54,5%) hombres. La mayoría de la población eran personas de estratos socioeconómicos 1 y 2, nivel de educación primaria incompleta y en el momento de la evaluación se encontraban en su hogar o desempleados (Ver Tabla 1 En relación al contexto socio-demográfico, llama la atención el bajo nivel de escolaridad de los pacientes, perteneciendo la mayoría al régimen subsidiado y todos a los estratos socioeconómicos 1 a 3; este factor tiene gran relevancia en EPOC [15][16][17] , se considera que los pacientes tienen mayor riesgo de desarrollar complicaciones al tener una mayor probabilidad de presentar un deficiente estado nutricional, hacinamiento, exposición a contaminantes, entre ellos el tabaquismo y la biomasa; desarrollo de infecciones respiratorias y dificultades en el acceso a la atención de la salud 4,15 .…”

Características da fadiga no pré e pós-operatórios de cirurgia de revascularização do miocárdio

“…Caso a resposta fosse afirmativa, aplicava-se o Índice de Dispneia do Medical Research Concil Modificada -MRC modificada (Anexo 7) (164,179,180) .…”

“…Seu escore varia de 0 a 4, no qual, 0 indica dispneia ao realizar exercício intenso e 4, dispneia importante que limita a realização de atividades diárias como vestir-se, tomar banho sozinho ou sair de casa (164,179,180) .…”