BACKGROUND Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. METHODS We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. RESULTS Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8-51.7] and decreased productivity (presenteeism) of 20.0% [0.0-40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0-16.7]. The total population reported 40.0% [20.0-60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47-10.36), smoking (B = 5.97, 95%CI = 1.73-10.22), and solid fuel use (B = 3.94, 95%CI = 0.56-7.31) were potentially modifiable risk factors for impairment. CONCLUSIONS In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.

中文翻译：

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全球资源匮乏地区慢性肺病的社会经济负担-一项新鲜空气观察性研究。

背景技术由于儿童早期的不利因素和室内/室外空气污染，慢性肺病给低资源环境带来了不成比例的负担。但是，在这些情况下，呼吸道疾病对社会经济影响的数据非常缺乏。因此，我们旨在评估全球各种资源匮乏地区与慢性肺病相关的社会经济负担。为了告知政府和卫生政策，我们集中于工作生产力和活动损害及其可修改的临床和环境风险因素。方法我们在乌干达，越南，吉尔吉斯斯坦和希腊进行了横断面观察性新鲜空气研究。我们在肺活量测定诊断的COPD和/或哮喘患者中使用经验证的问卷对慢性肺病相关的社会经济负担进行了评估（总N = 1040）。使用多元线性回归模型，包括人口统计资料（例如年龄，性别），健康参数（呼吸困难，合并症）和慢性肺部疾病的危险因素（吸烟，使用固体燃料），研究了较高负担的预测因素。我们对每个国家/地区应用了相同的模型，随后对其进行了荟萃分析。结果受雇患者报告说，由于慢性肺病引起的[IQR]总体工作损害中位数为30％[1.8-51.7]，而生产力（表现主义）降低了20.0％[0.0-40.0]。值得注意的是，错过的工作时间（旷工）为0.0％[0.0-16.7]。总人口报告其日常活动受损40.0％[20.0-60.0]。呼吸困难严重程度（MRC等级）（B = 8.92，95％CI = 7.47-10.36），吸烟（B = 5.97，95％CI = 1.73-10.22）和固体燃料使用（B = 3.94，95％CI = 0.56） -7。31）是潜在的可修改的损害风险因素。结论在资源贫乏的地区，与大量表现力和活动障碍相比，慢性肺病相关的旷工率相对较低。可能由于缺乏社会保障体系，很少有人以减少生产率为代价休假。呼吸困难（MRC评分），吸烟和使用固体燃料可能会导致更高的损伤。结果表明，卫生政策制定者和医护人员在资源匮乏的环境中可以提高对肺部疾病的认识，预防措施和临床管理。由于缺乏社会保障体系，因此相对较少的人以减少生产率为代价休假几天。呼吸困难（MRC评分），吸烟和使用固体燃料可能会导致更高的损伤。结果表明，卫生政策制定者和医护人员在资源匮乏的环境中可以提高对肺部疾病的认识，预防措施和临床管理。由于缺乏社会保障体系，因此相对较少的人以减少生产率为代价休假几天。呼吸困难（MRC评分），吸烟和固体燃料的使用可能会导致更高的障碍。结果表明，卫生政策制定者和医护人员在资源匮乏的环境中可以提高对肺部疾病的认识，预防措施和临床管理。