論文No1443
Unemployment in chronic airflow obstruction around the world: results from the BOLD study
Rune Grønseth, Marta Erdal, Wan C. Tan, Daniel O. Obaseki, Andre F.S. Amaral, Thorarinn Gislason, Sanjay K. Juvekar, Parvaiz A. Koul, Michael Studnicka, Sundeep Salvi, Peter Burney, A. Sonia Buist, William M. Vollmer, Ane Johannessen
European Respiratory Journal 2017 50: 1700499; DOI: 10.1183/13993003.00499-2017
＜背景＞
慢性気流閉塞(CAO)と解雇の関連について世界中で調べた。
＜方法＞
Burden of Obstructive Lung Disease (BOLD)研究において26の施設からの横断的データを使用してCAOが解雇に及ぼす影響を解析した。
40-65歳の人の解雇に対するオッズ比を多レベル混合効果線形モデルでランダム効果として評価した。
施設ごとのばらつきは個別参加者のメタ解析で評価した。
＜結果＞
18710名の参加者のうち、11.3%にCAOがあった。
CAOのある人の解雇率をCAOがない人の解雇率で割った比率はかなりの施設による乖離を認めた。
しかし、年齢、性別、喫煙、教育で補正すると差はなかった。
解雇に対する施設補正オッズ比((95% CI)はCAOありで1.79 (1.41–2.27)であり、社会背景因子、合併症、努力性肺活量で補正すると1.43 (1.14–1.79)であった。
解雇に関連する他の共変数のうち、年齢、教育が高収入の施設では4.02 (3.53–4.57)および3.86 (2.80–5.30)と重要なリスク因子であり、中等度から低収入の施設では女性が重要なリスク因子 (3.23 (2.66–3.91))であった。
＜感想＞
世界的なBOLD試験において、CAOは各種因子で補正した後でも解雇率を高めたという結果でした。
We aimed to examine associations between chronic airflow obstruction (CAO) and unemployment across the world.
Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) study were used to analyse effects of CAO on unemployment. Odds ratios for unemployment in subjects aged 40–65 years were estimated using a multilevel mixed-effects generalised linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses.
Out of 18 710 participants, 11.3% had CAO. The ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, although these were no longer significant after adjusting for age, sex, smoking and education. The site-adjusted odds ratio (95% CI) for unemployment was 1.79 (1.41–2.27) for CAO cases, decreasing to 1.43 (1.14–1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (4.02 (3.53–4.57) and 3.86 (2.80–5.30), respectively), while female sex was important in low- to middle-income sites (3.23 (2.66–3.91)).
In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function.