Geographical Distribution of COPD Prevalence in the Americas

Spatial patterns and sociodemographic predictors of chronic obstructive pulmonary disease in Florida

Background

Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory respiratory disease that obstructs airflow and decreases lung function and is a leading cause death globally. In the United States (US), the prevalence among adults is 6.2%, but increases with age to 12.8% among those 65 years or older. Florida has one of the largest populations of older adults in the US, accounting for 4.5 million adults 65 years or older. This makes Florida an ideal geographic location for investigating COPD as disease prevalence increases with age. Understanding the geographic disparities in COPD and potential associations between its disparities and environmental factors as well as population characteristics is useful in guiding intervention strategies. Thus, the objectives of this study are to investigate county-level geographic disparities of COPD prevalence in Florida and identify county-level socio-demographic predictors of COPD prevalence.

Methods

This ecological study was performed in Florida using data obtained from the US Census Bureau, Florida Health CHARTS, and County Health Rankings and Roadmaps. County-level COPD prevalence for 2019 was age-standardized using the direct method and 2020 US population as the standard population. High-prevalence spatial clusters of COPD were identified using Tango's flexible spatial scan statistics. Predictors of county-level COPD prevalence were investigated using multivariable ordinary least squares model built using backwards elimination approach. Multicollinearity of regression coefficients was assessed using variance inflation factor. Shapiro-Wilks, Breusch Pagan, and robust Lagrange Multiplier tests were used to assess for normality, homoskedasticity, and spatial autocorrelation of model residuals, respectively.

Results

County-level age-adjusted COPD prevalence ranged from 4.7% (Miami-Dade) to 16.9% (Baker and Bradford) with a median prevalence of 9.6%. A total of 6 high-prevalence clusters with prevalence ratios >1.2 were identified. The primary cluster, which was also the largest geographic cluster that included 13 counties, stretched from Nassau County in north-central Florida to Charlotte County in south-central Florida. However, cluster 2 had the highest prevalence ratio (1.68) and included 10 counties in north-central Florida. Together, the primary cluster and cluster 2 covered most of the counties in north-central Florida. Significant predictors of county-level COPD prevalence were county-level percentage of residents with asthma and the percentage of current smokers.

Conclusions

There is evidence of spatial clusters of COPD prevalence in Florida. These patterns are explained, in part, by differences in distribution of some health behaviors (smoking) and co-morbidities (asthma). This information is important for guiding intervention efforts to address the condition, reduce health disparities, and improve population health.

Development and evaluation of the Rural and Northern Community Focused Model of COPD Care (RaNCoM)

BACKGROUND

The prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients.

METHODS

A process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted.

RESULTS

We describe five phases of the COPD program's development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation.

CONCLUSION

Team-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.

The Intention of Inhaled Medication Adherence Scale (IMAS): The Development of a New Instrument for Assessing Inhaled Medication Adherence Among Patients with Chronic Obstructive Pulmonary Disease (COPD) Using Theory of Planned Behavior

Purpose

Inhaled medication adherence is an important issue for patients with chronic obstructive pulmonary disease (COPD) because adhering to inhaled medications could substantially improve their health. However, patients with COPD may not be always adhere to the prescribed inhaled medications. Therefore, understanding the underlying reasons for patients with COPD adhering to inhaled medications is important. The present study used Theory of Planned Behavior (TPB) as a theoretical framework to develop the Intention of Inhaled Medication Adherence Scale (IMAS) and assess its psychometric properties.

Patients and Methods

After reviewing papers using the TPB to design psychometric scales and the TPB scale development guidelines, 28 items were generated for expert evaluation. Eight experts reported that the 28 items all had good content validity (content validity index ranged from 0.88 to 1.00 at item-level; and from 0.981 to 0.987 at scale-level) comprising four factors. Following initial development, 235 patients with COPD (mean age 73.12 years; 93.6% males) completed the IMAS via interview with a respiratory therapist and a research assistant. The four-factor structure of the IMAS was evaluated using confirmatory factor analysis (CFA).

Results

Nine IMAS items were removed because of low factor loadings or offending estimates. The 19-item IMAS was confirmed as having a four-factor structure supported by the CFA results (comparative fit index=1.00; Tucker-Lewis index=1.00; root mean square error of approximation=0.00; standardized root mean square residual=0.06).

Conclusion

The 19-item IMAS had satisfactory psychometric properties in construct validity. The 19-item IMAS is an instrument that could help healthcare providers understand potential factors associated with adherence to inhaled medications among people with COPD.

Health Literacy and Health Outcomes in Chronic Obstructive Pulmonary Disease Patients: An Explorative Study

Aim

This study aimed to evaluate the relationship between health literacy (HL) and chronic obstructive pulmonary disease (COPD) severity.

Methods

Pulmonary function test, sociodemographic features, Modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), and the European Health Literacy Survey Questionnaire were used. The study examined 13,760 patients who underwent a pulmonary function test. Out of 13,760 patients, 673 patients had FEV1/FVC values less than 70%. Those with FEV1/FVC< 0.70 (n = 336) after the reversibility test were included in the study.

Results

There was a significant decrease in HL and an increase in COPD severity (p < 0.001). In multivariate analysis, the risk of severe COPD was 2.74 times higher in patients in the poor income level than in patients in the good income level. In patients with inadequate HL, the risk of developing severe COPD was 1.80 times higher. A significant difference was found in HL index scores among the groups in terms of education level and income level (p < 0.001; p < 0.001, respectively). The most difficult topics for patients with COPD were periodic health examinations, good practices in mental health, and adult vaccinations.

Conclusions

Patients with COPD were found to be at a HL level well below the expected level. The risk of severe COPD increased with poor income and inadequate HL. Healthcare providers should be careful in accessing, understanding, and interpreting the health information of patients with inadequate HL. Therefore, patient education should be prioritized in the follow-up and in the treatment of patients with COPD. Physicians should pay maximum attention to patients with COPD in the regular use of drugs, their proper use, in taking preventive measures, and in adult vaccination.

Ambient air pollution and hospitalization for chronic obstructive pulmonary disease: Benefits from Three-Year Action Plan

BACKGROUND

Chronic obstructive pulmonary disease (COPD) hospitalization has been linked with ambient air pollution. However, the evidence on respiratory health benefits from air pollution control policy in China is limited.

OBJECTIVE

To investigate benefits from the Three-Year Action Plan to Win the Battle for a Blue Sky (TYAP) for tackling COPD hospitalization due to ambient air pollution.

METHODS

We conducted a time-stratified case-crossover study of 138,015 COPD hospitalizations aged ≥ 60 years in Guangdong province, China during 2016-2019 to investigate respiratory health benefits from TYAP. Inverse distance weighting method was used to assess daily individual-level exposures to ambient air pollutants including particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). Conditional logistic regression model was applied to analyze the associations between ambient air pollutants and COPD hospitalization.

RESULTS

TYAP can modify the associations. Each 10 μg/m3 increase of exposure to PM2.5, PM10, and NO2 and 1 mg/m3 increase of exposure to CO were significantly associated with 2.5%, 2.0%, 3.0%, and 14.4% increase in odds of COPD hospitalization before TYAP, respectively; while 1.0%, 0.9%, 1.5%, and 5.8% increase in odds during TYAP. We found prominent declines in health burden of COPD hospitalizations due to air pollution among the elderly after TYAP implication when compared with that before TYAP.

CONCLUSION

Reduced levels of ambient air pollutants by TYAP can effectively lower the risk for COPD hospitalization among the elderly, which provides evidence on the respiratory health benefits from consistent and effective air pollution control policy.

Impact of High-Density Urban Built Environment on Chronic Obstructive Pulmonary Disease: A Case Study of Jing'an District, Shanghai

Respiratory health is a focus of interdisciplinary studies involving urban planning and public health. Studies have noted that urban built environments have impacts on respiratory health by influencing air quality and human behavior such as physical activity. The aim of this paper was to explore the impact of urban built environments on respiratory health, taking chronic obstructive pulmonary disease (COPD) as one of the typical respiratory diseases for study. A cross-sectional study was conducted including all cases (N = 1511) of death from COPD in the high-density Jing'an district of Shanghai from 2001 to 2010. Proxy variables were selected to measure modifiable features of urban built environments within this typical high-density district in Shanghai. A geographically weighted regression (GWR) model was used to explore the effects of the built environment on the mortality of COPD and the geographical variation in the effects. This study found that land use mix, building width-height ratio, frontal area density, and arterial road density were significantly correlated to the mortality of COPD in high-density urban area. By identifying built environment elements adjustable by urban planning and public policy, this study proposes corresponding environmental intervention for respiratory health.