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Suri TM, Ghosh T, Mittal S, Hadda V, Madan K, Mohan A. Prevalence of chronic obstructive pulmonary disease in Indian nonsmokers: a systematic review & meta-analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 0:reveh-2023-0135. [PMID: 38016010 DOI: 10.1515/reveh-2023-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Nonsmokers with chronic obstructive pulmonary disease (COPD) are neglected despite constituting half of all cases in studies from the developed world. Herein, we systematically reviewed the prevalence of COPD among nonsmokers in India. CONTENT We searched Embase, Scopus, and PubMed databases for studies examining the prevalence of COPD among nonsmokers in India. We used the Joanna Briggs Institute (JBI) checklist to assess included studies' quality. Meta-analysis was performed using random-effects model. SUMMARY Seven studies comprising 6,903 subjects were included. The quality of the studies ranged from 5/9 to 8/9. The prevalence of COPD varied between 1.6 and 26.6 %. Studies differed considerably in demographics and biomass exposure profiles of subjects. Among the four studies that enrolled both middle-aged and elderly Indian nonsmokers not screened based on biomass fuel exposure, the pooled prevalence of COPD was 3 % (95 % CI, 2-3 %; I2=50.52 %, p=0.11). The pooled prevalence of COPD among biomass fuel-exposed individuals was 10 % (95 % CI, 2-18 %; I2=98.8 %, p<0.001). OUTLOOK Limited evidence suggests a sizable burden of COPD among nonsmokers and biomass fuel-exposed individuals in India. More epidemiological studies of COPD in nonsmokers are needed from low and middle-income countries.
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Affiliation(s)
- Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Abudiab S, Fuller-Thomson E. Flourishing despite Chronic Obstructive Pulmonary Disease (COPD): Findings from a Nationally Representative Survey of Canadians Aged 50 and Older. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16337. [PMID: 36498409 PMCID: PMC9735626 DOI: 10.3390/ijerph192316337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality and is often associated with serious disability and depression. Little is known about the characteristics of those who are in complete mental health (CMH) despite having COPD. This study’s objectives are to: (1) estimate the prevalence and odds of absence of psychiatric disorders (APD) and CMH among older adults that reported having COPD, compared to their peers that did not; (2) identify factors associated with APD and with CMH. Bivariate and logistic regression analyses were conducted using the nationally representative Canadian Community Health Survey—Mental Health. The results indicate that there was a significantly (p < 0.001) lower prevalence of APD (86.7% vs. 95.0%) and CMH (66.7% vs. 77.0%) among older adults aged 50+ with COPD (n = 703) compared to those without COPD (n = 10,189). Half of the sample was female (50.5%) and the majority of whom were under age 70 (62.5%). Factors significantly (p < 0.05) associated with higher odds of APD and of CMH among older adults with COPD include being married, having a confidant, being physically active, and having no lifetime history of major depressive disorder or generalized anxiety disorder. For every additional adverse childhood experience, the odds of APD declined by 31%. The majority of those with COPD are mentally flourishing despite having this disabling and life-threatening disorder. These findings underline the importance of targeted interventions and outreach to those most vulnerable to poorer mental health outcomes including the socially isolated.
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Affiliation(s)
- Sally Abudiab
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1V4, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, ON M5S 1V4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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3
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Kumar W, Shaikh W, KP S, Bhatty S, Hassan S. Electrocardiographic Abnormalities in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Cureus 2021; 13:e20820. [PMID: 35141077 PMCID: PMC8799956 DOI: 10.7759/cureus.20820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: The objective of this article was to determine the frequency of different electrocardiographic (ECG) abnormalities in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Design: This is a cross-sectional study. Place and duration: The study was conducted at the medicine department at Civil Hospital Karachi, Pakistan, between November 2018 and May 2019. Method: Both female and male participants aged 18-60 years with acute exacerbation of COPD (as per the operational definition) for more than three days who did not receive any treatment for exacerbation were included in the study. Twelve-lead ECG was recorded (Schiller AG, Baar, Switzerland) for 10 minutes after the supine rest, with a 50 mm/s of paper speed, 10 mm/mV of gain, and filter default settings. Results: In total, 140 participants (male: n = 124 [88.6%] and female: n = 16 [11.4%]) were included the research. The mean age of the participants was 40.43 ± 11.51 years. In terms of severity, 46 (32.95) patients presented with mild, 46 (32.9%) with moderate, and 48 (34.4%) with severe exacerbation. Moreover, 33 (23.65%) participants had ECG abnormalities, i.e., 13 (9.3%) patients presented with right atrial enlargement, and eight (5.7%) with right ventricular hypertrophy. Patients with a longer smoking duration (years) were likely to present with ECG abnormalities. Conclusion: Patients with COPD who had severe acute exacerbation and a long smoking duration have a high prevalence of ECG abnormalities. Hence, ECG may be a valuable tool for detecting ischemic abnormalities among patients with COPD, independent of previously known heart disease, in clinical settings.
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Liu H, Tan X, Liu Z, Ma X, Zheng Y, Zhu B, Zheng G, Hu Y, Fang L, Hong G. Association Between Diet-Related Inflammation and COPD: Findings From NHANES III. Front Nutr 2021; 8:732099. [PMID: 34733875 PMCID: PMC8558221 DOI: 10.3389/fnut.2021.732099] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/23/2021] [Indexed: 02/01/2023] Open
Abstract
Background and Aims: Little is known about diet-related inflammation in chronic obstructive pulmonary disease (COPD). In this study, we aimed to explore the association between COPD and dietary inflammatory index (DII) scores in adults over 40 years old. Methods: Data were obtained from the 2013 to 2018 National Health and Nutrition Examination Survey (NHANES). In the present study, 9,929 participants were included and analyzed. The DII score was calculated and divided into tertiles. Logistic regression analysis was performed to determine the odds ratios of DII tertiles. Results: Participants were categorized into COPD (565, 5.69%) and non-COPD groups (9,364, 94.31%) according to interview information. COPD individuals had higher DII scores than non-COPD individuals (0.429 ± 1.809 vs. −0.191 ± 1.791, p < 0.001). The highest DII score tertile included 46.55% of COPD individuals was associated with lower family incomes and education and a higher smoking rate (p < 0.01). The odds ratios (95% CIs) of COPD according to logistic regression were 0.709 (0.512–0.982) for T1 and 0.645 (0.475–0.877) for T2 of the DII score (p = 0.011). Conclusion: Higher DII scores were positively correlated with COPD in participants over 40 years old. These results further support that diet can be used as an intervention strategy for COPD management.
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Affiliation(s)
- Haiyue Liu
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Xilan Tan
- Division of Infection Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zuheng Liu
- Department of Cardiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiaobo Ma
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Yanqing Zheng
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Bo Zhu
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Gangsen Zheng
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Yuehong Hu
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Lili Fang
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Guolin Hong
- The Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China
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An independently validated, portable algorithm for the rapid identification of COPD patients using electronic health records. Sci Rep 2021; 11:19959. [PMID: 34620889 PMCID: PMC8497529 DOI: 10.1038/s41598-021-98719-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
Electronic health records (EHR) provide an unprecedented opportunity to conduct large, cost-efficient, population-based studies. However, the studies of heterogeneous diseases, such as chronic obstructive pulmonary disease (COPD), often require labor-intensive clinical review and testing, limiting widespread use of these important resources. To develop a generalizable and efficient method for accurate identification of large COPD cohorts in EHRs, a COPD datamart was developed from 3420 participants meeting inclusion criteria in the Mass General Brigham Biobank. Training and test sets were selected and labeled with gold-standard COPD classifications obtained from chart review by pulmonologists. Multiple classes of algorithms were built utilizing both structured (e.g. ICD codes) and unstructured (e.g. medical notes) data via elastic net regression. Models explicitly including and excluding spirometry features were compared. External validation of the final algorithm was conducted in an independent biobank with a different EHR system. The final COPD classification model demonstrated excellent positive predictive value (PPV; 91.7%), sensitivity (71.7%), and specificity (94.4%). This algorithm performed well not only within the MGBB, but also demonstrated similar or improved classification performance in an independent biobank (PPV 93.5%, sensitivity 61.4%, specificity 90%). Ancillary comparisons showed that the classification model built including a binary feature for FEV1/FVC produced substantially higher sensitivity than those excluding. This study fills a gap in COPD research involving population-based EHRs, providing an important resource for the rapid, automated classification of COPD cases that is both cost-efficient and requires minimal information from unstructured medical records.
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Balkissoon R. Journal Club: The Intersection of Racial/Ethnic Disparities in Coronavirus Disease 2019 and COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:292-302. [PMID: 33909967 DOI: 10.15326/jcopdf.2021.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Roberts JD, Dickinson KL, Koebele E, Neuberger L, Banacos N, Blanch-Hartigan D, Welton-Mitchell C, Birkland TA. Clinicians, cooks, and cashiers: Examining health equity and the COVID-19 risks to essential workers. Toxicol Ind Health 2020; 36:689-702. [PMID: 33241763 PMCID: PMC7691477 DOI: 10.1177/0748233720970439] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In Spring/Summer 2020, most individuals living in the United States experienced several months of social distancing and stay-at-home orders because of the coronavirus (COVID-19) pandemic. Clinicians, restaurant cooks, cashiers, transit operators, and other essential workers (EWs), however, continued to work outside the home during this time in order to keep others alive and maintain a functioning society. In the United States, EWs are often low-income persons of color who are more likely to face socioeconomic vulnerabilities, systemic racism, and health inequities. To assess the various impacts of COVID-19 on EWs, an online survey was distributed to a representative sample of individuals residing in six states during May/June 2020. The sample included 990 individuals who identified as EWs and 736 nonessential workers (NWs). We assessed differences between EW and NW respondents according to three categories related to health equity and social determinants of health: (1) demographics (e.g. race/ethnicity); (2) COVID-19 exposure risk pathways (e.g. ability to social distance); and (3) COVID-19 risk perceptions (e.g. perceived risk of contracting COVID-19). EWs were more likely to be Black or Hispanic than NWs and also had lower incomes and education levels on average. Unsurprisingly, EWs were substantially more likely to report working outside the home and less likely to report social distancing and wearing masks indoors as compared to NWs. EWs also perceived a slightly greater risk of contracting COVID-19. These findings, which we discuss in the context of persistent structural inequalities, systemic racism, and health inequities within the United States, highlight ways in which COVID-19 exacerbates existing socioeconomic vulnerabilities faced by EWs.
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Affiliation(s)
- Jennifer D Roberts
- Department of Kinesiology, School of Public Health, 1068University of Maryland, College Park, MD, USA
| | - Katherine L Dickinson
- Department of Environmental and Occupational Health, 144805Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Elizabeth Koebele
- Department of Political Science, 6851University of Nevada, Reno, NV, USA
| | - Lindsay Neuberger
- Nicholson School of Communication and Media, 6243University of Central Florida, Orlando, FL, USA
| | - Natalie Banacos
- Department of Environmental and Occupational Health, 144805Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | | | - Courtney Welton-Mitchell
- Department of Environmental and Occupational Health, 144805Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Thomas A Birkland
- Department of Public Administration, 6798NC State University, Raleigh, NC, USA
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8
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Akbarshahi H, Ahmadi Z, Currow DC, Sandberg J, Vandersman Z, Shanon-Honson A, Ekström M. No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial. ERJ Open Res 2020; 6:00342-2020. [PMID: 33263044 PMCID: PMC7682677 DOI: 10.1183/23120541.00342-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/18/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction COPD is a major cause of morbidity and mortality. The prevalence, morbidity and mortality of COPD among females have increased. Previous studies indicate a possible gender bias in the diagnosis and management of COPD. The present study aims to determine if there is gender bias in the management of COPD in Sweden. Methods This was a double-blind, randomised (1:1), controlled, parallel-group, web-based trial using the hypothetical case scenario of a former smoker (40 pack-years and quit smoking 3 years ago) who was male or female. The participants were blind to the randomisation and the purpose of the trial. The case progressively revealed more information with associated questions on how the physician would manage the patient. Study participants chose from a list of tests and treatments at each step of the case scenario. Results In total, 134 physicians were randomised to a male (n=62) or a female (n=72) case. There was no difference in initial diagnosis (61 (98%) male cases and 70 (97%) female cases diagnosed with COPD) and planned diagnostic procedures between the male and female cases. Spirometry was chosen by all the physicians as one of the requested diagnostic tests. The management of the hypothetical COPD case did not differ by sex of the responding physician. Conclusion In Sweden, diagnosis and management of a hypothetical patient with COPD did not differ by the gender of the patient or physician. No gender-related bias in COPD managementhttps://bit.ly/3gTsWoG
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Affiliation(s)
- Hamid Akbarshahi
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Zainab Ahmadi
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jacob Sandberg
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Zac Vandersman
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Aaron Shanon-Honson
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Magnus Ekström
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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9
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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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10
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Syamlal G, Doney B, Mazurek JM. Chronic Obstructive Pulmonary Disease Prevalence Among Adults Who Have Never Smoked, by Industry and Occupation - United States, 2013-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:303-307. [PMID: 30946736 PMCID: PMC6611472 DOI: 10.15585/mmwr.mm6813a2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Tobacco smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), a debilitating respiratory condition with high mortality and morbidity (1,2). However, an estimated 24% of adults with COPD have never smoked (3,4). Among these persons, 26%-53% of COPD can be attributed to workplace exposures, including dust, fumes, gases, vapors, and secondhand smoke exposure (4-6). To assess industry-specific and occupation-specific COPD prevalence among adults aged ≥18 years who have never smoked and who were employed any time during the past 12 months, CDC analyzed 2013-2017 National Health Interview Survey (NHIS) data. Among an estimated 106 million workers who had never smoked, 2.2% (2.4 million) have COPD. Highest prevalences were among workers aged ≥65 years (4.6%), women (3.0%), and those reporting fair/poor health (6.7%). Among industries and occupations, the highest COPD prevalences were among workers in the information industry (3.3%) and office and administrative support occupations (3.3%). Among women, the highest prevalences were among those employed in the information industry (5.1%) and in the transportation and material moving occupation (4.5%), and among men, among those employed in the agriculture, forestry, fishing, and hunting industry (2.3%) and the administrative and support, waste management, and remediation services industry (2.3%). High COPD prevalences in certain industries and occupations among persons who have never smoked underscore the importance of continued surveillance, early identification of COPD, and reduction or elimination of COPD-associated risk factors, such as the reduction of workplace exposures to dust, vapors, fumes, chemicals, and exposure to indoor and outdoor air pollutants.
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Affiliation(s)
- Girija Syamlal
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Brent Doney
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, Morgantown, West Virginia
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11
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Jindal SK. Chronic obstructive pulmonary disease in non-smokers - Is it a different phenotype? Indian J Med Res 2018; 147:337-339. [PMID: 29998868 PMCID: PMC6057250 DOI: 10.4103/ijmr.ijmr_10_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Surinder K Jindal
- Emeritus Professor, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research & Medical Director, Jindal Clinics, Chandigarh 160 020, India
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12
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Fuller-Thomson E, Howden KEN, Fuller-Thomson LR, Agbeyaka S. A Strong Graded Relationship between Level of Obesity and COPD: Findings from a National Population-Based Study of Lifelong Nonsmokers. J Obes 2018; 2018:6149263. [PMID: 30584475 PMCID: PMC6280223 DOI: 10.1155/2018/6149263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/18/2018] [Indexed: 12/19/2022] Open
Abstract
Factors associated with chronic obstructive pulmonary disease (COPD) among never-smokers have received little research attention. One potential risk factor for COPD is obesity, which is of particular importance in light of the global obesity epidemic. The objective of this study was to investigate the association between COPD and levels of obesity in a nationally representative sample of non-Hispanic white never-smokers. Data were drawn from the 2012 Center for Disease Control's Behavioral Risk Factor Surveillance System (BRFSS). Pearson's chi-square tests and logistic regression analyses were conducted in a large nationally representative sample of non-Hispanic white respondents aged 50 and over (76,004 women; 37,618 men) who reported that they had never smoked. A dose-response relationship was observed for both men and women: the prevalence of COPD increased from 2.5% in men and 3.5% in women who were of a healthy weight (BMI < 25) to 7.6% in men and 13.4% in women who had a BMI of 40 or higher. Even after adjusting for 7 potential confounds (e.g., age, education, and income), the odds of COPD were 3.21 higher for men (95% CI = 2.46, 4.20) and 4.00 higher for women with class III obesity (95% CI = 3.52, 4.55) in comparison with those of healthy weight. Regular screening for COPD is warranted in never-smoking obese patients who are aged 50 and over. Future research is needed to investigate plausible mechanisms for this association, including (1) the role of chronic inflammation associated with obesity and (2) the impact of central obesity on respiratory system mechanics.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work and Department of Family and Community Medicine, Director, Institute of Life Course & Aging, University of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada M5S 1A1
| | - Kaitlyn E. N. Howden
- McMaster University, Michael G. DeGroote School of Medicine, 1280 Main Street West, Michael DeGroote Centre for Learning and Discovery, Hamilton, Canada ON L8S 4K1
| | - Lilia R. Fuller-Thomson
- Institute of Life Course & Aging, University of Toronto, 246 Bloor St. W., Room 238, Toronto, Ontario, Canada M5S 1V4
| | - Senyo Agbeyaka
- Factor-Inwentash Faculty of Social Work and University Health Network, 246 Bloor St. W., Room 238, Toronto, Ontario, Canada M5S 1V4
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13
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Axelsson Fisk S, Mulinari S, Wemrell M, Leckie G, Perez Vicente R, Merlo J. Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. SSM Popul Health 2018; 4:334-346. [PMID: 29854918 PMCID: PMC5976844 DOI: 10.1016/j.ssmph.2018.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Socioeconomic, ethnic and gender disparities in Chronic Obstructive Pulmonary Disease (COPD) risk are well established but no studies have applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework to study this outcome. We study individuals at the first level of analysis and combinations of multiple social and demographic categorizations (i.e., intersectional strata) at the second level of analysis. Here we used MAIHDA to assess to what extent individual differences in the propensity of developing COPD are at the intersectional strata level. We also used MAIHDA to determine the degree of similarity in COPD incidence of individuals in the same intersectional stratum. This leads to an improved understanding of risk heterogeneity and of the social dynamics driving socioeconomic and demographic disparities in COPD incidence. Using data from 2,445,501 residents in Sweden aged 45–65, we constructed 96 intersectional strata combining categories of age, gender, income, education, civil- and migration status. The incidences of COPD ranged from 0.02% for young, native males with high income and high education who cohabited to 0.98% for older native females with low income and low education who lived alone. We calculated the intra-class correlation coefficient (ICC) that informs on the discriminatory accuracy of the categorizations. In a model that conflated additive and interaction effects, the ICC was good (20.0%). In contrast, in a model that measured only interaction effects, the ICC was poor (1.1%) suggesting that most of the observed differences in COPD incidence across strata are due to the main effects of the categories used to construct the intersectional matrix while only a minor share of the differences are attributable to intersectional interactions. We found conclusive interaction effects. The intersectional MAIHDA approach offers improved information to guide public health policies in COPD prevention, and such policies should adopt an intersectional perspective. We use multilevel analysis of individual heterogeneity and discriminatory accuracy. There is a clear difference in COPD incidence between intersectional strata. Intersectionality improves mapping of socioeconomic differences in COPD incidence. Preventive measures should be based on intersectional rather than classic analyses.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - Shai Mulinari
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - Maria Wemrell
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - George Leckie
- Centre for Multilevel Modelling, University of Bristol, UK
| | | | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden.,Center for Primary Health Research, Region Skåne, Malmö, Sweden
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Osman S, Ziegler C, Gibson R, Mahmood R, Moraros J. The Association between Risk Factors and Chronic Obstructive Pulmonary Disease in Canada: A Cross-sectional Study Using the 2014 Canadian Community Health Survey. Int J Prev Med 2017; 8:86. [PMID: 29142652 PMCID: PMC5672655 DOI: 10.4103/ijpvm.ijpvm_330_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 01/26/2023] Open
Abstract
Background: The global prevalence of chronic obstructive pulmonary disease (COPD) is expected to increase and the disease is projected to be the third leading cause of death by the year 2020. The purpose of this study was to measure the prevalence and determine the risk factors for COPD in Canada. Methods: This is a cross-sectional study that uses data from a nationally generalizable survey, the Canadian Community Health Survey, 2014. There were 46,924 respondents aged 35 years or older. Uni- and multi-variate logistic regression analyses were conducted to determine the risk factors associated with COPD. Results: The overall prevalence of COPD in the surveyed population was 5.69%. Results from multivariate logistic regression showed that COPD was significantly higher among individuals who were 65 years or older (odds ratio [OR] =4.43; 95% confidence interval [CI]: 3.69–5.33), current smokers (OR = 5.13; 95% CI: 4.43–5.95), underweight or obese by body mass index ([OR = 1.81; 95% CI: 1.38–2.38] and [OR = 1.58; 95% CI: 1.41–1.77], respectively), with a total personal income of <$20,000 (OR = 3.67; 95% CI: 2.95–4.57,), and some postsecondary education (OR = 1.42; 95% CI: 1.14–1.76). Immigrants were less likely to have COPD compared to Canadian-born respondents (OR = 0.67; 95% CI: 0.57–0.79). Conclusions: COPD is a growing and serious public health issue in Canada. The risk factors identified in this study provide useful targets to health promotion and education initiatives, health-care providers, and public health organizations to decrease the prevalence of COPD.
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Affiliation(s)
- Selma Osman
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Chelsea Ziegler
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Randie Gibson
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Razi Mahmood
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - John Moraros
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
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