Exploring the relationship between education, living environment, and anxiety/depression among stable patients: insights from the COPD-AD China Registry study

Abstract

Abstract Background The relationship between education and living environment is complex, and both factors are related to mental health. However, few studies have examined the independent and combined effects of education and living environment on mental health among patients with chronic obstructive pulmonary disease (COPD). Methods We analyzed data for 1064 patients with COPD enrolled in the COPD-AD China Registry study from 2017 to 2021. Binary logistic regression was used to analyze the independent and combined effects of education and living environment on patients’ mental health. We also evaluated additive interactions with the relative excess risk ratio (RERI), attribution percentage (AP), and synergy index (SI). Results Our primary analysis revealed the incidence of anxiety and depression was associated with educational level and living environment. After adjustment for potential confounding factors, binary logistic regression analyses showed 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) and depression (OR:1.62, 95% CI 1.17–2.27 and OR: 2.01, 95% CI 1.46–2.75) among patients with COPD. Our secondary analysis showed that the combination of low education level and living in urban areas was associated with the highest and significantly increased risk for anxiety (OR: 7.90, 95% CI 3.83–16.29, P < .001) or depression (OR: 11.79, 95% CI 5.77–24.10, P < .001) among these patients. Furthermore, we observed strong synergistic additive interactions between low education level and living in urban areas 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). Conclusions Our study suggests that mental health among patients with COPD is influenced by their education and living environment. Patients who have low education levels and live in urban areas may experience more anxiety and depression. Trial registration The clinical trial registration code was obtained from the ClinicalTrials.gov (date of registration: 14/06/2017, registration number: NCT03187236).