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Klitgaard A, Ibsen R, Hilberg O, Løkke A. Urban-rural and socio-economic differences in inhaled corticosteroid treatment for chronic obstructive pulmonary disease: A nationwide register-based cross-sectional study. Respir Med 2024; 229:107678. [PMID: 38815657 DOI: 10.1016/j.rmed.2024.107678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Urban-rural disparities within chronic obstructive pulmonary disease (COPD) have been documented in USA, but not in Europe. Inhaled corticosteroids (ICS) are widely used in COPD despite strict recommendations. We aimed to investigate urban-rural and socioeconomic differences in ICS treatment for COPD. METHODS A Danish nationwide register-based cross-sectional study. All patients alive on the December 31, 2018 with a J44 ICD-10 diagnosis code (COPD) were included (99,057 patients). Daily average ICS dose was calculated from the accumulated ICS use during 2018 based on redeemed prescriptions. Patients were divided into groups: No ICS, low dose ICS, medium dose ICS, high dose ICS. A multinomial logistic regression model including educational level, co-habitation status, age, and sex was performed with "No ICS" as reference group. RESULTS Compared to capital municipalities, living in other municipality types was associated with an increased probability of receiving medium and high dose ICS treatment, and increasing odds ratios (ORs) were seen with increasing ICS dose (medium dose ICS: ORs between 1.31 (95 % confidence interval (CI) 1.24-1.38) and 1.35 (95%CI 1.28-1.41), high dose ICS: ORs between 1.73 (95%CI 1.59-1.88) and 1.80 (95%CI 1.68-1.92)). Patients had increased probability of receiving ICS treatment if they were female, were co-habiting, or had completed only primary education. CONCLUSION Patients with a hospital-registered COPD diagnosis in non-capital municipalities receive more ICS, and in higher doses, compared to patients in capital municipalities. This is the first study to confirm that such urban-rural differences exist in Europe, and further research on this area is warranted.
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Affiliation(s)
- Allan Klitgaard
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Internal Medicine, University Hospital Lillebaelt, Vejle, Denmark.
| | | | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Internal Medicine, University Hospital Lillebaelt, Vejle, Denmark
| | - Anders Løkke
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Internal Medicine, University Hospital Lillebaelt, Vejle, Denmark
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Llamas-Saez C, Saez-Vaquero T, Jiménez-García R, López-de-Andrés A, Carabantes-Alarcón D, Zamorano-León JJ, Cuadrado-Corrales N, Omaña-Palanco R, de Miguel Diez J, Pérez-Farinos N. Physical activity among adults with chronic obstructive pulmonary disease in Spain (2014-2020): Temporal trends, sex differences, and associated factors. Respir Med 2023; 220:107458. [PMID: 37951312 DOI: 10.1016/j.rmed.2023.107458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/07/2023] [Accepted: 11/03/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES To evaluate trends in the prevalence of physical activity (PA) from 2014 to 2020; to identify sex differences and sociodemographic and health-related factors associated with PA in individuals with chronic obstructive pulmonary disease (COPD); and to compare PA between individuals with and without COPD. METHODS Cross-sectional and case-control study. SOURCE European Health Interview Surveys for Spain (EHISS) conducted in 2014 and 2020. We included sociodemographic and health-related covariates. We compared individuals with and without COPD after matching for age and sex. RESULTS The number of adults with COPD was 1086 and 910 in EHISS2014 and EHISS2020, respectively. In this population, self-reported "Medium or high frequency of PA" remained stable (42.9% in 2014 and 43.5% in 2020; p = 0.779). However, the percentage who walked on two or more days per week rose significantly over time (63.4%-69.9%; p = 0.004). Men with COPD reported more PA than women with COPD in both surveys. After matching, significantly lower levels of PA were recorded in COPD patients than in adults without COPD. Multivariable logistic regression confirmed this trend in COPD patients and showed that male sex, younger age, higher educational level, very good/good self-perceived health, and absence of comorbidities, obesity, and smoking were associated with more frequent PA. CONCLUSIONS The temporal trend in PA among Spanish adults with COPD is favorable, although there is much room for improvement. Insufficient PA is more prevalent in these patients than in the general population. Sex differences were found, with significantly more frequent PA among males with COPD.
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Affiliation(s)
- Carlos Llamas-Saez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Ana López-de-Andrés
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - David Carabantes-Alarcón
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - José J Zamorano-León
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Ricardo Omaña-Palanco
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Javier de Miguel Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28007, Madrid, Spain
| | - Napoleón Pérez-Farinos
- Epi-PHAAN Research Group, School of Medicine, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071, Málaga, Spain
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Nadeem SA, Comellas AP, Hoffman EA, Saha PK. Airway Detection in COPD at Low-Dose CT Using Deep Learning and Multiparametric Freeze and Grow. Radiol Cardiothorac Imaging 2022; 4:e210311. [PMID: 36601453 PMCID: PMC9806731 DOI: 10.1148/ryct.210311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To present and validate a fully automated airway detection method at low-dose CT in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS In this retrospective study, deep learning (DL) and freeze-and-grow (FG) methods were optimized and applied to automatically detect airways at low-dose CT. Four data sets were used: two data sets consisting of matching standard- and low-dose CT scans from the Genetic Epidemiology of COPD (COPDGene) phase II (2014-2017) cohort (n = 2 × 236; mean age ± SD, 70 years ± 9; 123 women); one data set consisting of low-dose CT scans from the COPDGene phase III (2018-2020) cohort (n = 335; mean age ± SD, 73 years ± 8; 173 women); and one data set consisting of low-dose, anonymized CT scans from the 2003 Dutch-Belgian Randomized Lung Cancer Screening trial (n = 55) acquired by using different CT scanners. Performance measures for different methods were computed and compared by using the Wilcoxon signed rank test. RESULTS At low-dose CT, 56 294 of 62 480 (90.1%) airways of the reference total airway count (TAC) and 32 109 of 37 864 (84.8%) airways of the peripheral TAC (TACp), detected at standard-dose CT, were detected. Significant losses (P < .001) of 14 526 of 76 453 (19.0%) airways and 884 of 6908 (12.8%) airways in the TAC and 12 256 of 43 462 (28.2%) airways and 699 of 3882 (18.0%) airways in the TACp were observed, respectively, for the multiprotocol and multiscanner data without retraining. When using the automated low-dose CT method, TAC values of 347, 342, 323, and 266 and TACp values of 205, 202, 289, and 141 were observed for those who have never smoked and participants at Global Initiative for Chronic Obstructive Lung Disease stages 0, 1, and 2, respectively, which were superior to the respective values previously reported for matching groups when using a semiautomated method at standard-dose CT. CONCLUSION A low-cost, automated CT-based airway detection method was suitable for investigation of airway phenotypes at low-dose CT.Keywords: Airway, Airway Count, Airway Detection, Chronic Obstructive Pulmonary Disease, CT, Deep Learning, Generalizability, Low-Dose CT, Segmentation, Thorax, LungClinical trial registration no. NCT00608764 Supplemental material is available for this article. © RSNA, 2022.
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Dahne J, Player MS, Strange C, Carpenter MJ, Ford DW, King K, Miller S, Kruis R, Hawes E, Hidalgo JE, Diaz VA. Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy. J Med Internet Res 2022; 24:e38663. [PMID: 36040766 PMCID: PMC9472044 DOI: 10.2196/38663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. OBJECTIVE The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. METHODS In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ≥2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration-approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ≥50%, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. RESULTS Of 85 participants assigned to the e-visits, 64 (75.3%) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6% (49/64) completed home spirometry, and 35.9% (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). CONCLUSIONS A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. TRIAL REGISTRATION ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Charlie Strange
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Dee W Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Kathryn King
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Sarah Miller
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Johanna E Hidalgo
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States
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Bhutani M, Price DB, Winders TA, Worth H, Gruffydd-Jones K, Tal-Singer R, Correia-de-Sousa J, Dransfield MT, Peché R, Stolz D, Hurst JR. Quality Standard Position Statements for Health System Policy Changes in Diagnosis and Management of COPD: A Global Perspective. Adv Ther 2022; 39:2302-2322. [PMID: 35482251 PMCID: PMC9047462 DOI: 10.1007/s12325-022-02137-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
Introduction Despite being a leading cause of death worldwide, chronic obstructive pulmonary disease (COPD) is underdiagnosed and underprioritized within healthcare systems. Existing healthcare policies should be revisited to include COPD prevention and management as a global priority. Here, we propose and describe health system quality standard position statements that should be implemented as a consistent standard of care for patients with COPD. Methods A multidisciplinary group of clinicians with expertise in COPD management together with patient advocates from eight countries participated in a quality standards review meeting convened in April 2021. The principal objective was to achieve consensus on global health system priorities to ensure consistent standards of care for COPD. These quality standard position statements were either evidence-based or reflected the combined views of the panel. Results On the basis of discussions, the experts adopted five quality standard position statements, including the rationale for their inclusion, supporting clinical evidence, and essential criteria for quality metrics. These quality standard position statements emphasize the core elements of COPD care, including (1) diagnosis, (2) adequate patient and caregiver education, (3) access to medical and nonmedical treatments aligned with the latest evidence-based recommendations and appropriate management by a respiratory specialist when required, (4) appropriate management of acute COPD exacerbations, and (5) regular patient and caregiver follow-up for care plan reviews. Conclusions These practical quality standards may be applicable to and implemented at both local and national levels. While universally applicable to the core elements of appropriate COPD care, they can be adapted to consider differences in healthcare resources and priorities, organizational structure, and care delivery capabilities of individual healthcare systems. We encourage the adoption of these global quality standards by policymakers and healthcare practitioners alike to inform national and regional health system policy revisions to improve the quality and consistency of COPD care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02137-x.
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Racial Disparities in Health Risk Indicators Reported by Alabamians Diagnosed with COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189662. [PMID: 34574587 PMCID: PMC8470414 DOI: 10.3390/ijerph18189662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/01/2021] [Accepted: 09/09/2021] [Indexed: 12/27/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a growing public health problem in the southern United States, particularly in Alabama. However, very little is known about specific health risk factors disproportionately impacting Alabamians with COPD. We conducted a latent class analysis of 2015–2019 Behavioral Risk Factor Surveillance System data from 4057 Alabamians with COPD (White = 2947, Black = 873, Other = 237). Eighteen risk indicators were examined across three health-related domains: (1) comorbidities, (2) limited healthcare access, and (3) substance use/abuse. Racial disparities between Black and white Alabamians with COPD were assessed using configural similarity analysis. Findings showed that almost one-third (31%) of Alabamians with COPD were in the high-risk class for eight comorbidities, and nearly one-half (48.88%) belonged to the high-risk class for limited healthcare access. Black Alabamians with COPD who did not have health insurance were much more likely to be at high risk for limited healthcare access (94.44%) when compared to their counterparts with insurance (5.56%), χ2(df = 2) = 1389.94, p < 0.0001. Furthermore, the proportion of high-risk, uninsured Black Alabamians with COPD (94.44%) substantially exceeded the percentage of high-risk, uninsured white Alabamians with COPD (59.70%). Most Alabamians with COPD (82.97%) were at low risk for substance use/abuse. Future research should explore new mechanisms for facilitating better healthcare access among high-risk Alabamians living with COPD and other prevalent comorbidities. Greater attention should be focused on Black Alabamians with COPD who cannot afford adequate health insurance.
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Tendedez H, Ferrario MA, McNaney R, Gradinar A. Respire: A Scenario-Based Tool to Explore Human-Data Interaction in Clinical Decision-Making (Preprint). JMIR Hum Factors 2021; 9:e32456. [PMID: 35522463 PMCID: PMC9123541 DOI: 10.2196/32456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/07/2022] [Accepted: 03/21/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Helena Tendedez
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Maria-Angela Ferrario
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, United Kingdom
| | - Roisin McNaney
- Department of Human Centred Computing, Monash University, Melbourne, Australia
| | - Adrian Gradinar
- Lancaster Institute for the Contemporary Arts, Lancaster University, Lancaster, United Kingdom
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Sicras-Mainar A, de Abajo FJ, Izquierdo-Alonso JL. Clinical and Economic Consequences of Inhaled Corticosteroid Doses and Particle Size in Triple Inhalation Therapy for COPD: Real-Life Study. Int J Chron Obstruct Pulmon Dis 2020; 15:3291-3302. [PMID: 33328730 PMCID: PMC7734046 DOI: 10.2147/copd.s281333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the clinical and economic consequences of inhaled corticosteroid doses and particle size in patients on triple-inhalation therapy for COPD. Methods Patients aged ≥40 years who initiated treatment with multi-inhaler triple-inhaled therapy between 1 January 2015 and 31 March were included and followed for 1 year. Patients were grouped according to inhaled corticosteroid (ICS) dose (low/medium/high) and particle size device (extrafine/non-extrafine particles). Outcome variables were moderate and severe exacerbations, pneumonia and healthcare resource use (HCRU) costs. A multivariate analysis was performed for model correction (p<0.05). Results A total of 2185 patients (mean age 72.3 years, 82.9% male) were analysed. Of these, 849 (38.9%) patients received low-dose ICS, 612 medium-dose ICS (28.0%) and 724 (33.1%) high-dose ICS. Exacerbations occurred more frequently with increasing IC dose (low: 26.4%, medium: 28.7% and high: 30.4%; p=0.047), as did the proportion of pneumonia (3.4%, 4.2% and 6.9%, respectively (p=0.041)). The annual mean cost/unit was € 2383 for low dose, € 2401 for medium dose and € 2625 for high dose (p=0.024). Four hundred and sixty-two (31.6%) patients used an extrafine particle device and 999 (68.4%) a non-extrafine particle device: the proportion of exacerbations was 24.0% vs 30.4% (p=0.012), and the annual mean cost/unit was € 2090 vs € 2513, respectively (p<0.001). The number of exacerbations was directly correlated with FEV1 (β= −0.157), age (β=0.071), Charlson index (β=0.050) and device type (extrafine: β=0.049) (p<0.02). Conclusion In patients with COPD receiving multi-inhaler triple therapy, higher ICS doses were not associated with a further reduction in exacerbations, whereas we found an increased risk of pneumonia. The use of inhaler devices delivering extrafine ICS particle was associated with a lower rate of exacerbations, resulting in lower overall HCRU costs.
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Affiliation(s)
| | - Francisco J de Abajo
- Unidad de Farmacología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,Departamento de Ciencias Biomédicas, Universidad de Alcalá (IRYCIS), Madrid, Spain
| | - José Luis Izquierdo-Alonso
- Departamento de Medicina y Especialidades, Universidad de Alcalá, Madrid, Spain.,Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Stellefson M, Wang MQ, Balanay JAG, Wu R, Paige SR. Latent Health Risk Classes Associated with Poor Physical and Mental Outcomes in Workers with COPD from Central Appalachian U.S. States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186798. [PMID: 32957739 PMCID: PMC7558335 DOI: 10.3390/ijerph17186798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/05/2020] [Accepted: 09/15/2020] [Indexed: 02/01/2023]
Abstract
Adults who work in the Central Appalachian region of the United States (U.S.) are disproportionately affected by Chronic Obstructive Pulmonary Disease (COPD). While there is a socio-demographic profile of adults with COPD who are at increased risk for physical and mental distress, the risk factors that uniquely affect the health-related quality of life (HRQoL) of Central Appalachian workers with COPD are unknown. Therefore, we conducted a latent class analysis of 2016 and 2017 Behavioral Risk Factor Surveillance System data from 1326 currently employed adults with COPD living in four U.S. states (KY, NC, TN, and WV) within the Central Appalachian Region. Drawing from the social ecological model, we identified associations between theoretically informed risk indicators-comorbid health conditions, substance use and abuse, and limited access to healthcare-on three HRQoL variables, including infrequent (0-13 days) or frequent (≥14 days) physical distress, mental distress, and limited activity due to poor health over the past 30 days. Workers at high risk for comorbid conditions reported more frequent physical distress, mental distress, and activity limitations as compared to those at low risk. Workers reporting difficulty accessing healthcare were no more likely to report physical or mental distress when compared to workers with adequate access to healthcare; however, those with limited healthcare access did report more frequent activity limitation due to poor health. Interestingly, workers with COPD at high risk for substance use and abuse were no more likely to report poor HRQoL outcomes compared to those at low risk. Our findings have important implications for addressing indicators of poor health among Central Appalachian workers with COPD, especially those living with multiple comorbidities.
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Affiliation(s)
- Michael Stellefson
- Department of Health Science, The University of Alabama, Tuscaloosa, AL 35487, USA
- Correspondence:
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, College Park, MD 20742, USA;
| | - Jo Anne G. Balanay
- Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA;
| | - Rui Wu
- Department of Computer Science, East Carolina University, Greenville, NC 27858, USA;
| | - Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA;
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Stellefson M, Wang MQ, Balanay JAG, Wu R. Health Risk Disparities among Employed Adults with COPD Living in Central Appalachian U.S. States. AMERICAN JOURNAL OF HEALTH EDUCATION 2020. [DOI: 10.1080/19325037.2020.1802373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nadeem SA, Hoffman EA, Comellas AP, Saha PK. Anatomical Labeling of Human Airway Branches using a Novel Two-Step Machine Learning and Hierarchical Features. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11313. [PMID: 34267414 DOI: 10.1117/12.2546004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common inflammatory disease associated with restricted lung airflow. Quantitative computed tomography (CT)-based bronchial measures are popularly used in COPD-related studies, which require both airway segmentation and anatomical branch labeling. This paper presents an algorithm for anatomical labeling of human airway tree branches using a novel two-step machine learning and hierarchical features. Anatomical labeling of airway branches allows standardized spatial referencing of airway phenotypes in large population-based studies. State-of-the-art anatomical labeling methods are associated with mandatory manual reviewing and correction for mislabeled branches-a time-consuming process susceptible to inter-observer variability. The new method is fully automated, and it uses hierarchical branch-level features from the current as well as ancestral and descendant branches. During the first machine learning step, it differentiates candidate anatomical branches from insignificant topological branches, often, responsible for variations in airway branching patterns. The second step is designed for lung lobe-based classification of anatomical labels for valid candidate branches. The machine learning classifiers has been designed, trained, and validated using total lung capacity (TLC) CT scans (n = 350) from the Iowa cohort of the nationwide COPDGene study during their baseline visits. One hundred TLC CT scans were used for training and validation, and a different set of 250 scans were used for testing and evaluative experiments. The new method achieved labeling accuracies of 98.4, 97.2, 92.3, 93.4, and 94.1% in the right upper, right middle, right lower, left upper, and left lower lobe, respectively, and an overall accuracy of 95.9%. For five clinically significant segmental branches, the method has achieved an accuracy of 95.2%.
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Affiliation(s)
- Syed Ahmed Nadeem
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA 52242
| | - Eric A Hoffman
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA 52242
| | - Alejandro P Comellas
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA 52242
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, USA 52242.,Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA 52242
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Raju S, Keet CA, Paulin LM, Matsui EC, Peng RD, Hansel NN, McCormack MC. Rural Residence and Poverty Are Independent Risk Factors for Chronic Obstructive Pulmonary Disease in the United States. Am J Respir Crit Care Med 2020; 199:961-969. [PMID: 30384774 DOI: 10.1164/rccm.201807-1374oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE In developing countries, poor and rural areas have a high burden of chronic obstructive pulmonary disease (COPD), and environmental pollutants and indoor burning of biomass have been implicated as potential causal exposures. Less is known about the prevalence of COPD in the United States with respect to urban-rural distribution, poverty, and factors that uniquely contribute to COPD among never-smokers. OBJECTIVES To understand the impact of urban-rural status, poverty, and other community factors on COPD prevalence nationwide and among never-smokers. METHODS We studied a nationally representative sample of adults in the National Health Interview Survey 2012-2015, with data linkage between neighborhood data from the U.S. Census's American Community Survey and the National Center for Health Statistics Urban-Rural Classification Scheme. The main outcome was COPD prevalence. MEASUREMENTS AND MAIN RESULTS The prevalence of COPD in poor, rural areas was almost twice that in the overall population (15.4% vs. 8.4%). In adjusted models, rural residence (odds ratio [OR], 1.23; P < 0.001) and census-level poverty (OR, 1.12; P = 0.012) were both associated with COPD prevalence, as were indicators of household wealth. Among never-smokers, rural residence was also associated with COPD (OR, 1.34; P < 0.001), as was neighborhood use of coal for heating (OR, 1.09; P < 0.001). CONCLUSIONS In a nationally representative sample, rural residence and poverty were risk factors for COPD, even among never-smokers. The use of coal for heating was also a risk factor for COPD among never-smokers. Future disparities research to elucidate contributors to COPD development in poor and rural areas, including assessments of heating sources and environmental pollutants, is needed.
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Affiliation(s)
| | | | - Laura M Paulin
- 1 Department of Medicine and.,3 Department of Environmental Health Sciences and
| | | | - Roger D Peng
- 4 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Nadia N Hansel
- 1 Department of Medicine and.,3 Department of Environmental Health Sciences and
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13
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Paige SR, Damiani RE, Flood-Grady E, Krieger JL, Stellefson M. The Perceived Availability of Online Social Support: Exploring the Contributions of Illness and Rural Identities in Adults with Chronic Respiratory Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010242. [PMID: 31905782 PMCID: PMC6982215 DOI: 10.3390/ijerph17010242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022]
Abstract
Joining an online social support group may increase perceived membership to a community, but it does not guarantee that the community will be available when it is needed. This is especially relevant for adults with Chronic Obstructive Pulmonary Disease (COPD), many of whom reside in rural regions and continually negotiate their illness identity. Drawing from social support literature and communication theory of identity, this cross-sectional study explored how COPD illness and geographic identities interact to influence patients’ perceived availability of online social support. In April 2018, 575 adults with a history of respiratory symptoms completed an online survey. Patients with a COPD diagnosis reported greater availability of online support. This was partially mediated by a positive degree of COPD illness identity (i.e., being diagnosed with COPD, a history of tobacco use, severe respiratory symptoms, high disease knowledge, and low income but high education). The relationship between COPD illness identity and the availability of online support was strongest among those with low rural identity; however, at lower levels of COPD illness identity, participants with high rural identity reported the greatest degree of available online support. Results have important implications for tailored education approaches across the COPD care continuum by illness and geographic identities.
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Affiliation(s)
- Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
- Correspondence:
| | - Rachel E. Damiani
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
- Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL 32610, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA;
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14
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Paige SR, Stellefson M, Krieger JL, Alber JM. Computer-Mediated Experiences of Patients with Chronic Obstructive Pulmonary Disease. AMERICAN JOURNAL OF HEALTH EDUCATION 2019; 50:127-134. [PMID: 31641399 DOI: 10.1080/19325037.2019.1571963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The Internet is an important tool for empowering patients with Chronic Obstructive Pulmonary Disease (COPD) to learn about and self-manage their condition. Purpose To understand which aspects of the online experience facilitates or hinders the perceived ability of patients with COPD to achieve their information and self-management goals. Methods Semi-structured interviews were conducted with medically underserved patients with COPD (N = 25) who access the Internet for health. A conventional content analysis approach was applied and data were analyzed with the constant comparative method. Results The following themes were derived: (1) desire to associate with "in-group" members; (2) relationship building with other online users; (3) security of information and identity; (4) source and channel credibility appraisal; (5) user assistance and tutorials; and (6) strategies to adapt technological functions. Discussion Success in using the Internet was dependent on the functional use of technology and the ability and resilience to engage with similar online users to build meaningful and trustworthy connections. Translation to Health Education Practice Prior to directing patients with COPD to a disease-specific online support platform, certified health education specialists must assess patients' information goals and their skills to critically appraise and communicate with other online users.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, Department of Health Education and Behavior, University of Florida, Gainesville FL 32611
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville NC 27858
| | - Janice L Krieger
- STEM Translational Communication Center, Department of Advertising, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville FL 32611
| | - Julia M Alber
- Kinesiology Department, California Polytechnic State University, San Luis Obispo CA 93407
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15
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Bousquet J, Mohammad Y, Bedbrook A, To T, McGihon R, Bárbara C, Melo-Gomes E, Rosado-Pinto J, Simão P, George F, Punturieri A, Kiley JP, Nunes E, Cossa A, Camargos P, Stelmach R, Cruz AA, Rostan MV, Yañez A, González-Díaz SN, Urrutia-Pereira M, Calderon MA, Gómez RM, German Z, Kolek V, Špičák V, Lan LTT, Hurd S, Lenfant C, Yorgancioglu A, Gemicioğlu B, Ekinci B, Ozkan Z, Abou Al-Zahab B, Dmeirieh A, Shifa R, Faroun H, AlJaber A, Halloum R, Fatmeh Y, Alzein A, Aloush J, Dib G, Shaaban R, Arrais M, do Céu Teixeira M, Conceição C, Ferrinho P. Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels. J Thorac Dis 2018; 10:7064-7072. [PMID: 30746253 DOI: 10.21037/jtd.2018.12.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jean Bousquet
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM, VIMA: Ageing and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Paris, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Yvelines, France.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
| | - Yousser Mohammad
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria.,Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Anna Bedbrook
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Rachel McGihon
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Cristina Bárbara
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Portugal
| | | | - José Rosado-Pinto
- Global Alliance against Chronic Respiratory Diseases (GARD) Portugal Coordinator, Serviço de Imunoalergologia, Hospital da Luz, Lisboa, Portugal
| | - Paula Simão
- Directorate-General of Health, Lisbon, Portugal
| | | | - Antonello Punturieri
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - James P Kiley
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabete Nunes
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Anilsa Cossa
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Paulo Camargos
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | | | | | - Moïses A Calderon
- Imperial College London, London, U.K.Royal Brompton Hospital, London, UK.,Universidad de Costa Rica, San Jose, Costa Rica
| | - René Maximiliano Gómez
- Fundación Ayre, Salta, Argentina.,School of Health Sciences, Catholic University of Salta, Argentina.,Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Salta, Argentina
| | - Zachary German
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, USA
| | - Vítězslav Kolek
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Václav Špičák
- Department of Pediatrics, Hospital Na Bulovce, Prague, Czech Republic
| | - Le Thi Tuyet Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Suzanne Hurd
- Global Initiative for Asthma (GINA), the Global Initiative for Chronic Obstructive Lung Disease (GOLD), Vancouver, WA, USA
| | - Claude Lenfant
- Global Initiative on Obstructive Lung Disease (GOLD), Gaithersburg, MD, USA
| | | | - Bilun Gemicioğlu
- Department of Chest Diseases, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu Ekinci
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | - Zubeyda Ozkan
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | | | | | | | | | - Aicha AlJaber
- National Professional Officer at WHO office in Syria, Damascus, Syria
| | - Ramsa Halloum
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Yassine Fatmeh
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Ghazal Dib
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Rafea Shaaban
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Cláudia Conceição
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
| | - Paulo Ferrinho
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
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16
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Stellefson M, Paige SR, Alber JM, Stewart M. COPD360social Online Community: A Social Media Review. Health Promot Pract 2018; 19:489-491. [DOI: 10.1177/1524839918779567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
People living with chronic obstructive pulmonary disease (COPD) commonly report feelings of loneliness and social isolation due to lack of support from family, friends, and health care providers. COPD360social is an interactive and disease-specific online community and social network dedicated to connecting people living with COPD to evidence-based resources. Through free access to collaborative forums, members can explore, engage, and discuss an array of disease-related topics, such as symptom management. This social media review provides an overview of COPD360social, specifically its features that practitioners can leverage to facilitate patient–provider communication, knowledge translation, and community building. The potential of COPD360social for chronic disease self-management is maximized through community recognition programming and interactive friend-finding tools that encourage members to share their own stories through blogs and multimedia (e.g., images, videos). The platform also fosters collaborative knowledge dissemination and helping relationships among patients, family members, friends, and health care providers. Successful implementation of COPD360social has dramatically expanded patient education and self-management support resources for people affected by COPD. Practitioners should refer patients and their families to online social networks such as COPD360social to increase knowledge and awareness of evidence-based chronic disease management practices.
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Affiliation(s)
| | | | - Julia M. Alber
- California Polytechnic State University, San Luis Obispo, CA, USA
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