因哮喘控制不佳致生产力损失的可预防负担
2015/02/25
摘要
背景：生产力损失是慢性疾病负担中容易被忽视的一个方面，然而当前指南强调哮喘管理达到临床控制，鲜有研究报道哮喘控制和生产力损失之间的关系。通过达到并维持临床控制，来计算可以避免的成年在职哮喘患者的生产力损失。
方法：在加拿大不列颠哥伦比亚省，前瞻性的招募以人群为基础的成年哮喘患者随机样本。我们用验证工具来衡量由旷工和假性出勤导致的生产力损失，并且按照GINA分级确定哮喘控制水平。在校正了潜在的混淆因素基础上，如果个体的哮喘水平在过去一周内得到控制，通过拟合两部分回归模型相关联的哮喘控制和生产力下降，我们估算每个个体平均涨幅生产力损失。
结果:最终样本包括300例在职成人(均数年龄47.9岁(标准差12.0);67.3%女性占67.3%)。其中,49例(16.3%)报道缺勤,137例(45.7%)报道假性出勤。由于假性出勤而不是缺勤导致的生产力下降与哮喘控制相关。一例未控制的哮喘患者通过达到临床控制，可以避免由于生产力下降造成的每星期亏损184.80(加元(CAD)), 其中167.50 CAD(90.6%)来源于假性出勤。部分控制的哮喘患者相应的34.20CAD并没有统计意义。
结论:我们的研究结果表明,通过获得哮喘控制可以大幅增加生产力。假性出勤比缺勤对哮喘控制更为敏感,因此,可预防负担的更重要来源为达到哮喘控制。
The Preventable Burden of Productivity Loss Due to Suboptimal Asthma Control
Sadatsafavi M，Rousseau R，Chen W，Zhang W，Lynd L，FitzGerald M，and the Economic Burden of Asthma Study Team *
ABSTRACT
BACKGROUND: Productivity loss is an overlooked aspect of the burden of chronic health conditions. While modern guidelines emphasize achieving clinical control in asthma management, few studies have reported on the relationship between asthma control and productivity loss. We calculated the productivity loss that can be avoided by achieving and maintaining clinical control in employed adults with asthma.
METHODS: We prospectively recruited a population-based random sample of adults with asthma in British Columbia, Canada. We measured productivity loss due to absenteeism and presenteeism using validated instruments, and ascertained asthma control according to the GINA (Global Initiative for Asthma) classification. We estimated the average gain in productivity for each individual if the individual’s asthma was controlled in the past week, by fitting two-part regression models associating asthma control and productivity loss, controlling for potential confounding
variables.
RESULTS: The final sample included 300 employed adults (mean age, 47.9 years [SD 12.0]; 67.3% women). Of these, 49 (16.3%) reported absenteeism, and 137 (45.7%) reported presenteeism. Productivity loss due to presenteeism, but not absenteeism, was associated with asthma control. A person with uncontrolled asthma would avoid $184.80 (Canadian dollars [CAD]) in productivity loss by achieving clinical control during a week, CAD$167.50 (90.6%) of which would be due to presenteeism. The corresponding value was CAD$34.20 for partially controlled asthma and was not statistically significant.
CONCLUSIONS: Our results indicate that substantial gain in productivity can be obtained by achieving asthma control. Presenteeism is more responsive than absenteeism to asthma control, and, thus, is a more important source of preventable burden.
CHEST 2014; 145(4):787–793
背景：生产力损失是慢性疾病负担中容易被忽视的一个方面，然而当前指南强调哮喘管理达到临床控制，鲜有研究报道哮喘控制和生产力损失之间的关系。通过达到并维持临床控制，来计算可以避免的成年在职哮喘患者的生产力损失。
方法：在加拿大不列颠哥伦比亚省，前瞻性的招募以人群为基础的成年哮喘患者随机样本。我们用验证工具来衡量由旷工和假性出勤导致的生产力损失，并且按照GINA分级确定哮喘控制水平。在校正了潜在的混淆因素基础上，如果个体的哮喘水平在过去一周内得到控制，通过拟合两部分回归模型相关联的哮喘控制和生产力下降，我们估算每个个体平均涨幅生产力损失。
结果:最终样本包括300例在职成人(均数年龄47.9岁(标准差12.0);67.3%女性占67.3%)。其中,49例(16.3%)报道缺勤,137例(45.7%)报道假性出勤。由于假性出勤而不是缺勤导致的生产力下降与哮喘控制相关。一例未控制的哮喘患者通过达到临床控制，可以避免由于生产力下降造成的每星期亏损184.80(加元(CAD)), 其中167.50 CAD(90.6%)来源于假性出勤。部分控制的哮喘患者相应的34.20CAD并没有统计意义。
结论:我们的研究结果表明,通过获得哮喘控制可以大幅增加生产力。假性出勤比缺勤对哮喘控制更为敏感,因此,可预防负担的更重要来源为达到哮喘控制。
(肖仁1 张红萍1 王刚1 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（CHEST 2014; 145(4):787–793)
（CHEST 2014; 145(4):787–793)
The Preventable Burden of Productivity Loss Due to Suboptimal Asthma Control
Sadatsafavi M，Rousseau R，Chen W，Zhang W，Lynd L，FitzGerald M，and the Economic Burden of Asthma Study Team *
ABSTRACT
BACKGROUND: Productivity loss is an overlooked aspect of the burden of chronic health conditions. While modern guidelines emphasize achieving clinical control in asthma management, few studies have reported on the relationship between asthma control and productivity loss. We calculated the productivity loss that can be avoided by achieving and maintaining clinical control in employed adults with asthma.
METHODS: We prospectively recruited a population-based random sample of adults with asthma in British Columbia, Canada. We measured productivity loss due to absenteeism and presenteeism using validated instruments, and ascertained asthma control according to the GINA (Global Initiative for Asthma) classification. We estimated the average gain in productivity for each individual if the individual’s asthma was controlled in the past week, by fitting two-part regression models associating asthma control and productivity loss, controlling for potential confounding
variables.
RESULTS: The final sample included 300 employed adults (mean age, 47.9 years [SD 12.0]; 67.3% women). Of these, 49 (16.3%) reported absenteeism, and 137 (45.7%) reported presenteeism. Productivity loss due to presenteeism, but not absenteeism, was associated with asthma control. A person with uncontrolled asthma would avoid $184.80 (Canadian dollars [CAD]) in productivity loss by achieving clinical control during a week, CAD$167.50 (90.6%) of which would be due to presenteeism. The corresponding value was CAD$34.20 for partially controlled asthma and was not statistically significant.
CONCLUSIONS: Our results indicate that substantial gain in productivity can be obtained by achieving asthma control. Presenteeism is more responsive than absenteeism to asthma control, and, thus, is a more important source of preventable burden.
CHEST 2014; 145(4):787–793
上一篇：
重度哮喘：以患者为导向的管理的演变
下一篇：
药物依从性与重度哮喘急性发作风险：一项系统评价
