Social inequalities in COPD incidence, mortality and exacerbations in a large Italian cohort

Résumé fourni par la source

Introduction: Inequalities in chronic obstructive pulmonary disease (COPD) are well recognised. However, the strength of the association between socioeconomic position (SEP) and COPD incidence and outcomes can vary by gender. Objectives: To analyse social inequalities in COPD onset, progression and survival in men and women living in Central Italy. Methods: We used the 2011 census cohort of residents in the Lazio region (central Italy), aged 50 years or more, followed through health administrative databases to identify COPD incident cases and their outcomes in 2012-2022. We used educational attainment as indicator of SEP. We used Poisson regression models, stratified by sex, to compute age adjusted rates and to study disparities in COPD incidence and outcomes (mortality and acute exacerbations). Results: In a population of 1,774,598 subjects (45% men), we identified 313,909 new COPD cases (46% men) during the follow-up. Compared to men with an university degree, the less-educated showed a higher incidence (RR=1.50 95%CI:1.47-1.53 in junior high school and RR=1.74 95%CI:1.71-1.77 in primary school, respectively), higher mortality (RR=1.20 95%CI:1.16-1.24 in junior high school and RR=1.28 95%CI:1.24-1.32 in primary school, respectively) and hospital admissions (RR=1.47 95%CI:1.30-1.67 in junior high school and 1.76 95%CI:1.56-1.98 in primary school, respectively). Compared to women with a university degree, those with a primary education had a 40% higher incidence, a 20% higher mortality, and no differences in COPD hospitalizations. Conclusions: There were socioeconomic inequalities in COPD incidence and mortality, stronger in men than in women, while inequalities in exacerbations in men only.

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