Exploring the Relationship Between Education, Living Environment, and Anxiety/Depression Among Stable Patients: Insights from the COPD-AD China Registry Study

Int J Chron Obstruct Pulmon Dis. 2024 Sep 23:19:2063-2071. doi: 10.2147/COPD.S455923. eCollection 2024.

Abstract

Background: Education and living environment are related to mental health. But the independent and combined effects of them on mental health among patients with chronic obstructive pulmonary disease (COPD) are uncertain.

Methods: The independent and combined effects of education and living environment on mental health were assessed by binary logistic regression in 1064 COPD patients. Additive interaction was assessed with the relative excess risk ratio (RERI), attribution percentage (AP), and synergy index (SI).

Results: Our results shown that low education level and urban living environment were independently associated with higher risks for anxiety (odds ratio [OR]: 1.56, 95% confidence interval [CI] 1.06-2.29 and OR:2.15, 95% CI 1.51-2.05) or depression (OR:1.62, 95% CI 1.17-2.27 and OR: 2.01, 95% CI 1.46-2.75) among COPD patients. The combination effect of them was also associated with higher risks for anxiety (OR: 7.90, 95% CI 3.83-16.29, P < 0.001) or depression (OR: 11.79, 95% CI 5.77-24.10, P < 0.001) among these patients. Furthermore, we observed strong synergistic additive interactions between them for anxiety (SI: 11.57, 95% CI 1.41-95.27; RERI: 6.31, 95% CI 1.60-11.01; AP: 0.8, 95% CI 0.66-0.94) and depression (SI: 31.31, 95% CI 1.59-617.04; RERI: 10.44, 95% CI 2.66-18.23; AP: 0.89, 95% CI 0.8-0.97).

Conclusion: Low education levels and living in urban areas had an independent and synergistic effects on mental health among COPD patients.

Keywords: COPD; China; anxiety; depression; education; living environment.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Anxiety* / diagnosis
  • Anxiety* / epidemiology
  • Anxiety* / psychology
  • China / epidemiology
  • Cross-Sectional Studies
  • Depression* / diagnosis
  • Depression* / epidemiology
  • Depression* / psychology
  • Educational Status*
  • Female
  • Humans
  • Male
  • Mental Health*
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • Pulmonary Disease, Chronic Obstructive* / psychology
  • Registries*
  • Residence Characteristics
  • Risk Assessment
  • Risk Factors
  • Social Determinants of Health
  • Urban Health

Grants and funding

This research was supported by the National Key Research and Development Program of China (grant number: 2016YFC1304404), the Guangdong Medical Science and Technology Research Fund Project (grant number: B2021294), the Discipline Construction Project of Guangdong Medical University (grant number: 4SG21231G), the Clinical Research Project of Affiliated Hospital of Guangdong Medical University (grant numbers: LCYT2017A003, LCYJ2020B008, LCYJ2021B007), and the Project of Zhanjiang City (grant numbers: 2021A05052, 2021A05077).