Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study
BackgroundChronic obstructive pulmonary disease (COPD) is a major cause of global morbidity and mortality, with socioeconomic status (SES) playing a significant role in disease outcomes. While the impact of individual SES on COPD has been reported, the influence of both individual and neighborhood S...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1584945/full |
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| author | Hyewon Lee Hyewon Lee Jiyun Jung Hee-Young Yoon |
| author_facet | Hyewon Lee Hyewon Lee Jiyun Jung Hee-Young Yoon |
| author_sort | Hyewon Lee |
| collection | DOAJ |
| description | BackgroundChronic obstructive pulmonary disease (COPD) is a major cause of global morbidity and mortality, with socioeconomic status (SES) playing a significant role in disease outcomes. While the impact of individual SES on COPD has been reported, the influence of both individual and neighborhood SES on clinical outcomes remains unclear. We aimed to evaluate the association between SES and COPD outcomes.MethodWe conducted a retrospective cohort study using 2015–2018 data from the Korean National Health Insurance Service-National Sample Cohort, linked with census data. SES was assessed at both individual (income, insurance type) and neighborhood levels (residential area, elderly proportion, education level, gross regional domestic product, and total population density). Outcomes included overall mortality and hospitalization, which were evaluated using Cox proportional hazard models adjusted for demographic and air pollution.ResultsAmong 12,820 patients (mean age 63.5 years, 47.2% male), higher income was significantly associated with lower mortality risk (hazard ratio [HR] = 0.961, 95% confidence interval [CI] = 0.936–0.986) in the adjusted model. Suburban residence was associated with increased mortality risk (HR = 1.432, 95% CI = 1.089–1.884), while rural residence was not significant after adjustment. For hospitalization, higher income was also significantly associated with a lower risk (HR = 0.987, 95% CI = 0.979–0.995). Suburban (HR = 1.097, 95% CI = 1.013–1.187) and rural (HR = 1.138, 95% CI = 1.046–1.239) residence also remained significantly associated with increased hospitalization risk in the adjusted models. Additionally, a higher proportion of older adults (HR = 1.010, 95% CI = 1.004–1.016) and lower educational attainment (HR = 0.992, 95% CI = 0.989–0.995) were also significantly associated with hospitalization risk.ConclusionThese findings suggest that individual SES is associated with both mortality and hospitalization among patients with COPD, while neighborhood SES influences hospitalization but not mortality after adjustment. |
| format | Article |
| id | doaj-art-d5d2fe0110954ded96765f3fceeb498f |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-d5d2fe0110954ded96765f3fceeb498f2025-08-20T03:19:17ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-06-011210.3389/fmed.2025.15849451584945Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort studyHyewon Lee0Hyewon Lee1Jiyun Jung2Hee-Young Yoon3Department of Health Administration and Management, College of Medical Sciences, Soonchunhyang University, Asan, Republic of KoreaDepartment of Software Convergence, Soonchunhyang University Graduate School, Asan, Republic of KoreaDepartment of Biostatistics, Dongguk University College of Medicine, Gyeongju, Republic of KoreaDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of KoreaBackgroundChronic obstructive pulmonary disease (COPD) is a major cause of global morbidity and mortality, with socioeconomic status (SES) playing a significant role in disease outcomes. While the impact of individual SES on COPD has been reported, the influence of both individual and neighborhood SES on clinical outcomes remains unclear. We aimed to evaluate the association between SES and COPD outcomes.MethodWe conducted a retrospective cohort study using 2015–2018 data from the Korean National Health Insurance Service-National Sample Cohort, linked with census data. SES was assessed at both individual (income, insurance type) and neighborhood levels (residential area, elderly proportion, education level, gross regional domestic product, and total population density). Outcomes included overall mortality and hospitalization, which were evaluated using Cox proportional hazard models adjusted for demographic and air pollution.ResultsAmong 12,820 patients (mean age 63.5 years, 47.2% male), higher income was significantly associated with lower mortality risk (hazard ratio [HR] = 0.961, 95% confidence interval [CI] = 0.936–0.986) in the adjusted model. Suburban residence was associated with increased mortality risk (HR = 1.432, 95% CI = 1.089–1.884), while rural residence was not significant after adjustment. For hospitalization, higher income was also significantly associated with a lower risk (HR = 0.987, 95% CI = 0.979–0.995). Suburban (HR = 1.097, 95% CI = 1.013–1.187) and rural (HR = 1.138, 95% CI = 1.046–1.239) residence also remained significantly associated with increased hospitalization risk in the adjusted models. Additionally, a higher proportion of older adults (HR = 1.010, 95% CI = 1.004–1.016) and lower educational attainment (HR = 0.992, 95% CI = 0.989–0.995) were also significantly associated with hospitalization risk.ConclusionThese findings suggest that individual SES is associated with both mortality and hospitalization among patients with COPD, while neighborhood SES influences hospitalization but not mortality after adjustment.https://www.frontiersin.org/articles/10.3389/fmed.2025.1584945/fullhealthcare disparitiesenvironmental exposuresurvival raterisk factorslongitudinal studies |
| spellingShingle | Hyewon Lee Hyewon Lee Jiyun Jung Hee-Young Yoon Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study Frontiers in Medicine healthcare disparities environmental exposure survival rate risk factors longitudinal studies |
| title | Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study |
| title_full | Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study |
| title_fullStr | Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study |
| title_full_unstemmed | Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study |
| title_short | Impact of socioeconomic status on chronic obstructive pulmonary disease prognosis: a national cohort study |
| title_sort | impact of socioeconomic status on chronic obstructive pulmonary disease prognosis a national cohort study |
| topic | healthcare disparities environmental exposure survival rate risk factors longitudinal studies |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1584945/full |
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