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Osundolire S, Goldberg RJ, Lapane KL. Differences in chronic obstructive pulmonary disease among US nursing home residents with heart failure according to sex and type of heart failure. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1130-1144. [PMID: 37712492 PMCID: PMC10632080 DOI: 10.1111/crj.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Heart failure and chronic obstructive pulmonary disease (COPD) are leading cause of death throughout the world. Few recent studies have, however, examined possible sex and type of heart failure (HFpEF, HFrEF, and unspecified/other heart failure) differences in the prevalence of these chronic conditions among nursing home residents. OBJECTIVES The aim of this study is to examine the magnitude of concomitant COPD and differences according to sex and heart failure type, in terms of the prevalence of COPD among nursing home residents with heart failure. METHODS The principal study outcomes were examined in a cross-sectional study of 97 495 US nursing home residents with heart failure using the 2018 Minimum Data Set. The diagnoses of heart failure and COPD were operationalized through a review of nursing home admission, progress notes, and physical examination findings. RESULTS The average age of this study population was 81.3 ± 11.0 years, 67.3% were women, and 53.8% had COPD. A slightly higher prevalence of COPD was found among men than women. A higher proportion of unspecified heart failure type was found in both men and women, than reduced and preserved ejection fractions, respectively. In both men and women, there was a higher prevalence of COPD among those with various chronic conditions and current tobacco users. CONCLUSIONS COPD is highly prevalent among medically complex middle-aged and older nursing home residents with heart failure. Future research should focus on increasing our understanding of factors that influence the risk and optimal management of COPD and heart failure to improve the quality of life for nursing home residents.
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Affiliation(s)
- Seun Osundolire
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Robert J. Goldberg
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Kate L. Lapane
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
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Carlson SA, Watson KB, Rockhill S, Wang Y, Pankowska MM, Greenlund KJ. Linking Local-Level Chronic Disease and Social Vulnerability Measures to Inform Planning Efforts: A COPD Example. Prev Chronic Dis 2023; 20:E76. [PMID: 37651645 PMCID: PMC10487786 DOI: 10.5888/pcd20.230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Data are publicly available to identify geographic differences in health outcomes, including chronic obstructive pulmonary disease (COPD), and social vulnerability; however, examples of combining data across sources to understand disease burden in the context of community vulnerability are lacking. METHODS We merged county and census tract model-based estimates of COPD prevalence from PLACES (www.cdc.gov/PLACES) with social vulnerability measures from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (https://www.atsdr.cdc.gov/placeandhealth/svi), including 4 themes (socioeconomic, household composition and disability, minority status and language, and housing type and transportation), and the overall Social Vulnerability Index (SVI). We used the merged data set to create vulnerability profiles by COPD prevalence, explore joint geographic patterns, and calculate COPD population estimates by vulnerability levels. RESULTS Counties and census tracts with high COPD prevalence (quartile 4) had high median vulnerability rankings (range: 0-1) for 2 themes: socioeconomic (county, 0.81; tract, 0.77) and household composition and disability (county, 0.75; tract, 0.81). Concordant high COPD prevalence and vulnerability for these themes were clustered along the Ohio and lower Mississippi rivers. The estimated number of adults with COPD residing in counties with high vulnerability was 2.5 million (tract: 4.7 million) for the socioeconomic theme and 2.3 million (tract: 5.0 million) for the household composition and disability theme (high overall SVI: county, 4.5 million; tract, 4.7 million). CONCLUSION Data from 2 publicly available tools can be combined, analyzed, and visualized to jointly examine local COPD estimates and social vulnerability. These analyses can be replicated with other measures to expand the use of these cross-cutting tools for public health planning.
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Affiliation(s)
- Susan A Carlson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341
| | - Kathleen B Watson
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Rockhill
- Geospatial Research, Analysis, and Services Program, Office of Innovation and Analytics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yan Wang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Magdalena M Pankowska
- Oak Ridge Institute for Science and Education, Research Participation Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Blaylock B, Niu X, Davidson HE, Gravenstein S, DePue R, Williams GR, Steinberg KE. Development of MDS-Based Predication Model for COPD Severity in Nursing Home Residents. Ann Pharmacother 2021; 56:878-887. [PMID: 34963317 DOI: 10.1177/10600280211059241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Assessing chronic obstructive pulmonary disease (COPD) severity is challenging in nursing home (NH) residents due to incomplete symptom assessments and exacerbation history. OBJECTIVE The objective of this study was to predict COPD severity in NH residents using the Minimum Data Set (MDS), a clinical assessment of functional capabilities and health needs. METHODS A cohort analysis of prospectively collected longitudinal data was conducted. Residents from geographically varied Medicare-certified NHs with age ≥60 years, COPD diagnosis, and ≥6 months NH residence at enrollment were included. Residents with severe cognitive impairment were excluded. Demographic characteristics, medical history, and MDS variables were extracted from medical records. The care provider-completed COPD Assessment Test (CAT) and COPD exacerbation history were used to categorize residents by Global Initiative for Chronic Lung Disease (GOLD) A to D groups. Multivariate multinomial logit models mapped the MDS to GOLD A to D groups with stepwise selection of variables. RESULTS Nursing home residents (N = 175) were 64% women and had a mean age of 77.9 years. Among residents, GOLD B was most common (A = 13.1%; B = 44.0%; C = 5.7%; D = 37.1%). Any long-acting bronchodilator (LABD) use and any dyspnea were significant predictors of GOLD A to D groups. The predicted MDS-GOLD group (A = 6.9%; B = 52.6%; C = 4.6%; D = 36.0%) showed good model fit (correctly predicted = 60.6%). Nursing home residents may underuse group-recommended LABD treatment (no LABD: B = 53.2%; C = 80.0%; D = 40.0%). CONCLUSION AND RELEVANCE The MDS, completed routinely for US NH residents, could potentially be used to estimate COPD severity. Predicted COPD severity with additional validation could provide a map to evidence-based treatment guidelines and may help to individualize treatment pathways for NH residents.
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Affiliation(s)
| | - Xiaoli Niu
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Stefan Gravenstein
- Department of Health Services, Policy and Practice, Center for Gerontology and Health Care Research, Brown University, Providence, RI, USA
| | - Ronald DePue
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - G Rhys Williams
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Karl E Steinberg
- Shiley Institute for Palliative Care, The California State University, San Marcos, CA, USA
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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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Davidson HE, Radlowski P, Han L, Shireman TI, Dembek C, Niu X, Gravenstein S. Clinical Characterization of Nursing Facility Residents With Chronic Obstructive Pulmonary Disease. Sr Care Pharm 2021; 36:248-257. [PMID: 33879286 DOI: 10.4140/tcp.n.2021.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE AND DESIGN To describe clinical characteristics, medication use, and low peak inspiratory flow rate (PIFR) (< 60 L/min) prevalence in nursing facility residents with chronic obstructive pulmonary disease (COPD). PATIENTS AND SETTING Residents 60 years of age and older with a COPD diagnosis and≥ 6 months' nursing facility residence, were enrolled between December 2017 and February 2019 from 26 geographically varied United States nursing facilities. OUTCOME MEASURES Data, extracted from residents' charts, included demographic/clinical characteristics, COPD-related medications, exacerbations and hospitalizations within the past 6 months, and functional status from the most recent Minimum Data Set. At enrollment, residents completed the modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT™). Spirometry and PIFR were also assessed. RESULTS Residents' (N = 179) mean age was 78.0 ± 10.6 years, 63.7% were female, and 57.0% had low PIFR. Most prevalent comorbidities were hypertension (79.9%), depression (49.2%), and heart failure (41.9%). The average forced expiratory volume in 1 second (FEV11) % predicted was 45.9% ± 20.9%. On the CAT, 78.2% scored≥ 10 and on the mMRC Dyspnea Scale, 74.1% scored≥ 2, indicating most residents had high COPD symptom burden. Only 49.2% were receiving a scheduled long-acting bronchodilator (LABD). Among those with low PIFR prescribed a LABD, > 80% used dry powder inhalers for medication delivery. CONCLUSION This study highlights underutilization of scheduled LABD therapy in nursing facility residents with COPD. Low PIFR was prevalent in residents while the majority used suboptimal medication delivery devices. The findings highlight opportunities for improving management and outcomes for nursing facility residents with COPD.
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Affiliation(s)
| | | | - Lisa Han
- 1Insight Therapeutics, LLC, Norfolk, Virginia
| | - Theresa I Shireman
- 2Brown University, Center for Gerontology and Health Care Research, Providence, Rhode Island
| | - Carole Dembek
- 3Sunovion Pharmaceuticals, Incorporated, Marlborough, Massachusetts
| | - Xiaoli Niu
- 3Sunovion Pharmaceuticals, Incorporated, Marlborough, Massachusetts
| | - Stefan Gravenstein
- 2Brown University, Center for Gerontology and Health Care Research, Providence, Rhode Island
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Fortis S, O'Shea AMJ, Beck BF, Comellas A, Vaughan Sarrazin M, Kaboli PJ. Association Between Rural Residence and In-Hospital and 30-Day Mortality Among Veterans Hospitalized with COPD Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:191-202. [PMID: 33564232 PMCID: PMC7866931 DOI: 10.2147/copd.s281162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 12/30/2022] Open
Abstract
Background We explored the relationship between rural residency and in-hospital mortality in patients hospitalized with COPD exacerbations. Methods We retrospectively analyzed COPD hospitalizations from 2011 to 2017 at 124 acute care Veterans Health Administration (VHA) hospitals in the US. Patient residence was classified using Rural Urban Commuting Area codes as urban, rural, or isolated rural. We stratified patient hospitalizations into quartiles by travel time from patient residence to the nearest VHA primary care provider clinic and hospital. Multivariate analyses utilized generalized estimating equations with a logit link accounting for repeated hospitalizations among patients and adjusting for patient- and hospital-level characteristics. Results Of 64,914 COPD hospitalizations analyzed, 43,549 (67.1%) were for urban, 18,673 (28.8%) for rural, and 2,692 (4.1%) for isolated rural veterans. In-hospital mortality was 4.9% in urban, 5.5% in rural, and 5.2% in isolated rural veterans (P=0.008). Thirty-day mortality was 8.3% in urban, 9.9% in rural, and 9.2% in isolated rural veterans (P<0.001). Travel time to a primary care provider and VHA hospital was not associated with in-hospital mortality among isolated rural and rural veterans. In the multivariable analysis, compared to urban veterans, isolated rural patients did not have increased mortality. Rural residence was not associated with in-hospital (OR=0.87; 95% CI=0.67-1.12, P=0.28) but was associated with increased 30-day mortality (OR=1.13; 95% CI=1.04-1.22, P=0.002). Transfer from another acute care hospital (OR=14.97; 95% CI=9.80-17.16, P<0.001) or an unknown/other facility (OR=33.05; 95% CI=22.66-48.21, P<0.001) were the strongest predictors of increased in-hospital mortality compared to patients coming from the outpatient sector. Transfer from another acute care facility was also a risk factor for 30-day mortality. Conclusion Potential gaps in post-discharge care of rural veterans may be responsible for the rural-urban disparities. Further research should investigate the exact mechanism that inter-hospital transfers affect mortality.
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Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Amy M J O'Shea
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Brice F Beck
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - Alejandro Comellas
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mary Vaughan Sarrazin
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Peter J Kaboli
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Djibo DA, Goldstein J, Ford JG. Prevalence of disability among adults with chronic obstructive pulmonary disease, Behavioral Risk Factor Surveillance System 2016-2017. PLoS One 2020; 15:e0229404. [PMID: 32106254 PMCID: PMC7046217 DOI: 10.1371/journal.pone.0229404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of disabilities is rising steadily, reflecting an aging population and an increasing burden of chronic conditions affecting quality of life. There are scant national data on the prevalence of disability among individuals with chronic obstructive pulmonary disease (COPD). The main objective was to estimate the prevalence of common disabilities among US-based individuals diagnosed with COPD. METHODS Data from the BRFSS, a national telephone survey examining health-related behaviors in 2016-2017 were analyzed. The study population consisted of individuals with self-reported COPD (N = 38352 in 2016 and N = 35423 in 2017). The prevalence of disabilities in hearing, vision, cognition, mobility, and independent living were obtained and adjusted with sampling weights. Healthcare access measures were described by type of disability. RESULTS Mobility disability had the highest prevalence of 45.9 (44.8-47.0) % in 2016 and 48.4 (47.3-49.5) % in 2017 among respondents with COPD. The prevalence of disabilities was highest among those 45-64 years old, except for hearing and cognition. Hearing disabilities were most prevalent among males with COPD while cognitive and mobility disabilities were most prevalent among females with COPD. While differences in the prevalence of disabilities were observed, access to health care was similar by disability type and age group among respondents. CONCLUSION Contrary to expectation, the highest prevalence of disabilities was found not to be among those 65 years old and above. Further research is needed to explain this age-specific shift in the burden of disability, as long-term care planning and prevention support systems should be informed by the demographical patterns of disabilities among individuals with COPD.
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Affiliation(s)
- Djeneba Audrey Djibo
- Division of Research, Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
- * E-mail:
| | - Jessica Goldstein
- Division of Research, Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
| | - Jean G. Ford
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
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Zafar M. Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease in Karachi Pakistan—A Cross-Sectional Study. MAMC JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mamcjms.mamcjms_92_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Chronic obstructive pulmonary disease (COPD) can be a disabling disease, and the impact on older adults is particularly evident in the nursing home setting. Chronic obstructive pulmonary disease is present in about 20% of nursing home residents, most often in women, and accounts for significant healthcare utilization including acute care visits for exacerbations and pneumonia, as well as worsening heart disease and diabetes mellitus. The emphasis on hospital readmissions is particularly important in nursing homes where institutions have quality measures that have financial implications. Optimizing drug therapies in individuals with COPD involves choosing medications that not only improve symptoms, but also decrease the risk of exacerbations. Optimizing the treatment of comorbidities such as heart disease, infections, and diabetes that may affect COPD outcomes is also an important consideration. Depending on the nursing home setting and the patient, the options for optimizing COPD drug therapies may be limited owing to patient-related factors such as cognition and physical impairment or available resources, primarily reimbursement-related issues. Choosing the best drug therapy for COPD in older adults is limited by the difficulty in assessing respiratory symptoms using standardized assessment tools and potentially decreased inspiratory ability of frail individuals. Because of cognitive and physical impediments, ensuring optimal delivery of inhaled medications into the lungs has significant challenges. Long-acting bronchodilators, inhaled corticosteroids, and roflumilast decrease the risk of exacerbations, although inhaled corticosteroids should be used judiciously in this population because of the risk of pneumonia and oropharyngeal side effects. Treatment of COPD exacerbations should occur early and consideration should be made to the benefits and risks of systemic corticosteroids and antibiotics. Clinical research in the COPD population in nursing homes is clearly lacking, and ripe for discovery of effective management strategies.
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Holt JB, Matthews KA, Lu H, Wang Y, LeClercq JM, Greenlund KJ, Thomas CW. Small Area Estimates of Populations With Chronic Conditions for Community Preparedness for Public Health Emergencies. Am J Public Health 2019; 109:S325-S331. [PMID: 31505141 PMCID: PMC6737821 DOI: 10.2105/ajph.2019.305241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To demonstrate a flexible and practical method to obtain near real-time estimates of the number of at-risk community-dwelling adults with a chronic condition in a defined area potentially affected by a public health emergency.Methods. We used small area estimation with survey responses from the 2016 Behavioral Risk Factor Surveillance System together with a geographic information system to predict the number of adults with chronic obstructive pulmonary disease who lived in the forecasted path of Hurricane Florence in North and South Carolina in 2018.Results. We estimated that a range of 32 002 to 676 536 adults with chronic obstructive pulmonary disease resided between 50 and 200 miles of 3 consecutive daily forecasted landfalls. The number of affected counties ranged from 8 to 10 (at 50 miles) to as many as 119 to 127 (at 200 miles).Conclusions. Community preparedness is critical to anticipating, responding to, and ameliorating these health threats. We demonstrated the feasibility of quickly producing detailed estimates of the number of residents with chronic conditions who may face life-threatening situations because of a natural disaster. These methods are applicable to a range of planning and response scenarios.
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Affiliation(s)
- James B Holt
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Kevin A Matthews
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Hua Lu
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Yan Wang
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Jennifer M LeClercq
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Kurt J Greenlund
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
| | - Craig W Thomas
- All authors are with the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA
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Matthews KA, Gaglioti AH, Holt JB, Wheaton AG, Croft JB. Using spatially adaptive floating catchments to measure the geographic availability of a health care service: Pulmonary rehabilitation in the southeastern United States. Health Place 2019; 56:165-173. [PMID: 30776768 PMCID: PMC6452632 DOI: 10.1016/j.healthplace.2019.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 11/15/2022]
Abstract
A spatially adaptive floating catchment is a circular area that expands outward from a provider location until the estimated demand for services in the nearest population locations exceeds the observed number of health care services performed at the provider location. This new way of creating floating catchments was developed to address the change of spatial support problem (COSP) by upscaling the availability of the service observed at a provider location to the county-level so that its geographic association with utilization could be measured using the same spatial support. Medicare Fee-for-Service claims data were used to identify beneficiaries aged ≥ 65 years who received outpatient pulmonary rehabilitation (PR) in the Southeastern United States in 2014 (n = 8798), the number of PR treatments these beneficiaries received (n = 132,508), and the PR providers they chose (n = 426). The positive correlation between PR availability and utilization was relatively low, but statistically significant (r = 0.619, p < 0.001) indicating that most people use the nearest available PR services, but some travel long distances. SAFCs can be created using data from health care systems that collect claim-level utilization data that identifies the locations of providers chosen by beneficiaries of a specific health care procedure.
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Affiliation(s)
- Kevin A Matthews
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States.
| | - Anne H Gaglioti
- National Center for Primary Care and Department of Family Medicine, Morehouse School of Medicine, United States
| | - James B Holt
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, United States
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Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med 2019; 8:jcm8010069. [PMID: 30634565 PMCID: PMC6352261 DOI: 10.3390/jcm8010069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in context of a “cardiopulmonary continuum” rather than being simply attributed to shared risk factors such as cigarette smoking. Overlapping symptoms such as dyspnea or chest pain lead to a worse prognosis due to missed concomitant diagnoses. Moreover, medication is often withheld as a result of unfounded concerns about side effects. Despite the frequent coincidence, current guidelines are still mostly restricted to the management of the individual disease. Future diagnostic and therapeutic strategies should therefore be guided by an integrative perspective as well as a refined phenotyping of disease entities.
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Caffrey C, Harris-Kojetin L, Rome V, Schwartz L. Relationships Between Residential Care Community Characteristics and Overnight Hospital Stays and Readmissions: Results From the National Study of Long-Term Care Providers. SENIORS HOUSING & CARE JOURNAL 2018; 26:38-49. [PMID: 31105807 PMCID: PMC6520986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
THE PROBLEM Hospitalizations and subsequent readmissions can produce significant challenges when trying to reduce costs and improve quality of care. This study describes hospitalizations and readmissions using residential care community data from the 2012 National Study of Long-Term Care Providers. THE RESOLUTION About 61.0% of residential care communities had hospitalizations, and among these communities, 39.3% had readmissions. Residential care communities in the Northeast were more likely to have had hospitalizations and readmissions. Residential care communities located in a continuing care retirement community (CCRC) had a lower likelihood of hospitalizations, and communities that provided therapeutic services had a lower likelihood of readmissions. TIPS FOR SUCCESS An association with a CCRC and provision of therapeutic services were found to be protective against hospitalizations and readmissions, respectively.
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Affiliation(s)
- Christine Caffrey
- Social Scientist, Long-Term Care Statistics Branch, National Center for Health Statistics, 3311 Toledo Road, #3518, Hyattsville, MD 20782,
| | - Lauren Harris-Kojetin
- Chief, Long-Term Care Statistics Branch, National Center for Health Statistics, 3311 Toledo Road, #3483, Hyattsville, MD 20782,
| | - Vincent Rome
- Health Scientist, Long-Term Care Statistics Branch, National Center for Health Statistics, 3311 Toledo Road, #3517 Hyattsville, MD 20782,
| | - Lindsay Schwartz
- Associate Vice President, Workforce and Quality, Improvement, American Health Care Association/National Center for Assisted Living, 1201 L Street N.W., Washington, DC 20005,
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Moayeri F, Dunt D, Hsueh YSA, Doyle C. Cost-utility analysis of telephone-based cognitive behavior therapy in chronic obstructive pulmonary disease (COPD) patients with anxiety and depression comorbidities: an application for willingness to accept concept. Expert Rev Pharmacoecon Outcomes Res 2018; 19:331-340. [PMID: 30324818 DOI: 10.1080/14737167.2019.1536550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study evaluated the cost-utility of telephone-based cognitive behavioral therapy (TB-CBT) (experimental arm) in comparison with a placebo-befriending (control arm) program in COPD participants with mild to severe depression and/or anxiety. METHODS The decision rule was based on willingness-to-pay if there is an increased unit of effectiveness (a quality-adjusted life year [QALY] gain) and an increase in cost, and willingness-to-accept (WTA) if there is a reduced unit of effectiveness (a QALY loss) and decrease in cost (a cost-saving). RESULTS TB-CBT group was associated with a reduction in the incremental cost of AUS-$407.3 (p < 0.001, SE:34.1) plus a negative, nonsignificant incremental QALY gain of -0.008 (SE:0.011) per patient compared to control group. The point estimate of the mean incremental cost-utility ratio was AUS$50,284.0 cost saving per QALY sacrificed (the high value associated with small QALY value in the denominator). Ninety-five percent CI was AUS$13,426 cost sacrificed to AUS$32,018 cost gain (lower values associated with larger QALY values in the denominator). If the societal's minimum (flooring threshold) WTA is AUS$64,000 per QALY forgone, the probability of TB-CBT being cost-effective was 42% Conclusions: This study showed that TB-CBT can be recommended as a cost-saving and preventive approach over usual care plus befriending program.
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Affiliation(s)
- Foruhar Moayeri
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - David Dunt
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - Ya-Seng Arthur Hsueh
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - Colleen Doyle
- b Australian Catholic University, Faculty of Health Sciences , School of Behavioural and Health Sciences (VIC), Villa Maria Catholic Homes , Kew Victoria , Australia
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15
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McDaniel JT. Prevalence of chronic obstructive pulmonary disease: county-level risk factors based on the Social Ecological Model. Perspect Public Health 2018; 138:200-208. [PMID: 29745294 DOI: 10.1177/1757913918772598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) was the third leading cause of death among Americans in 2014. Multiple factors, ranging from proximal (i.e. biological characteristics and behaviors) to distal (i.e. environmental characteristics and policies), have been shown to predict COPD outcomes. The Social Ecological Model (SEM), which specifies that five levels of influence (i.e. intrapersonal, interpersonal, institutional, community, and public policy factors) are implicated in the development of ill health, has not been used in epidemiological studies of COPD prevalence. A better understanding of the community-level correlates of COPD prevalence may improve community health practice. METHODS Using several sources of county-level secondary data ( n = 646), changes in COPD prevalence from 2012 to 2014 were predicted from the five levels of the SEM using ordinary least squares (OLS) hierarchical linear regression. The geographic distribution of county-level changes in COPD prevalence was analyzed with a choropleth map. RESULTS County-level COPD prevalence increased by 4.76% between 2012 and 2014 overall; however, the greatest increases were observed among counties within the Appalachian region (i.e. counties in West Virginia). Results showed that the SEM, with five levels of influence, was a statistically significant framework for examining changes in county-level COPD prevalence, F = 10.21, p < .001, R2 = 0.28. Statistically significant county-level predictors of changes in COPD prevalence included racial composition, ethnic composition, poverty, altitude, air pollution, and smoking policy. CONCLUSION COPD prevention may be assisted by the implementation of community-based programs rooted in a multilevel approach.
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Affiliation(s)
- J T McDaniel
- Assistant Professor of Public Health, Department of Public Health and Recreation Professions, Southern Illinois University, 475 Clocktower Drive, Mailcode 4632, Carbondale, IL 62901, USA
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16
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Chronic obstructive pulmonary disease in the long-term care setting: current practices, challenges, and unmet needs. Curr Opin Pulm Med 2018; 23 Suppl 1:S1-S28. [PMID: 28990958 DOI: 10.1097/mcp.0000000000000416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
: Chronic obstructive pulmonary disease (COPD) is a prevalent and disabling disorder in the United States, especially affecting older individuals, women, and those with a history of smoking. Studies show that COPD may be underrepresented, underdiagnosed, and undertreated in elderly patients residing in long-term care (LTC) facilities. The quality of care for LTC residents with COPD is heterogeneous in regard to both the facility and the patient. For LTC facilities, care should be driven by staff education, interstaff communication, and interfacility communication. From the perspective of the LTC patient, choice of medication and device should be based on appropriate diagnosis, comorbidities, ability to perform treatment, and patient preferences. Nebulization is currently underutilized in LTC settings, although it would benefit older patients with low peak inspiratory flow, cognitive impairment, and/or physical impairment, which may preclude them from using other inhalation devices. Authors developed a COPD treatment algorithm that focuses on three primary patient aspects to consider when deciding on respiratory device in patients in LTC facilities: inspiratory flow, hand dexterity and coordination, and cognitive capacity.
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17
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Kistler CE, Zimmerman S, Ward KT, Reed D, Golin C, Lewis CL. Health of Older Adults in Assisted Living and Implications for Preventive Care. THE GERONTOLOGIST 2017; 57:949-954. [PMID: 27053505 DOI: 10.1093/geront/gnw053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/20/2016] [Indexed: 12/18/2022] Open
Abstract
Purpose of the Study Older adults in residential care and assisted living (RC/AL) are less healthy than the general elderly population, and some have needs similar to those in nursing homes, making this an important group in which to assess potential overuse or underuse of preventive services. We determined the health status of RC/AL residents and distinguished characteristics between those who may and may not benefit from preventive services requiring a life expectancy ≥5 years. Design and Methods Cross-sectional survey of a nationally representative sample of RC/AL residents using 2010 data from the National Survey of Residential Care Facilities. The primary outcome was the weighted frequency distribution of health states using three predictive mortality indices: Charlson Comorbidity Index, 4-year mortality index, and 9-year mortality index. Results A total of 666,700 of 733,300 (weighted) residents met criteria for inclusion. Based on the three indices, 10%-15% were in good health, 11%-70% in intermediate health, and 20%-76% in poor health. Implications Using triangulation between 3 well-validated mortality indices, 10%-15% of RC/AL residents are in good health and highly likely to benefit from preventive services that require ≥5 year life expectancy. In addition, many residents have uncertain benefit and would benefit from shared decision making.
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Affiliation(s)
- Christine E Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,School of Social Work, University of North Carolina at Chapel Hill
| | - Kimberly T Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - David Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Carol Golin
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Carmen L Lewis
- Department of Medicine, School of Medicine, University of Colorado, Denver
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18
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Lin CS, Shih CC, Yeh CC, Hu CJ, Chung CL, Chen TL, Liao CC. Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease. PLoS One 2017; 12:e0169429. [PMID: 28060955 PMCID: PMC5217966 DOI: 10.1371/journal.pone.0169429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background The risk and outcomes of stroke in patients with chronic obstructive pulmonary disease exacerbations (COPDe) remain unclear. We examined whether patients with COPDe faced increased risk of stroke or post-stroke outcomes. Methods Using Taiwan’s National Health Insurance Research Database, we identified 1918 adults with COPDe and selected comparison cohorts of 3836 adults with COPD no exacerbations and 7672 adults without COPD who were frequency matched by age and sex in 2000–2008 (Study 1). Stroke event was identified during 2000–2013 follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke associated with COPDe were calculated. In a nested cohort study (Study 2) of 261686 new-diagnosed stroke patients in 2000–2009, we calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after stroke in patients with COPDe. Results Patients with COPDe had increased stroke incidence, with an adjusted HR of 1.28 (95% CI, 1.03–1.59). In the Study 2, COPDe were associated with post-stroke mortality (OR, 1.34, 95% CI 1.20–1.52), epilepsy (OR, 1.43; 95% CI, (1.22–1.67), and pneumonia (OR, 1.50; 95% CI, 1.39–1.62). Previous intubation for COPD and inpatient admissions due to COPD were factors associated with post-stroke adverse events. Conclusion Patients who have had COPDe face increased risks of stroke and post-stroke adverse events.
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Affiliation(s)
- Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, Illinois, United States of America
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chi-Li Chung
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- * E-mail:
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Wise RA, Acevedo RA, Anzueto AR, Hanania NA, Martinez FJ, Ohar JA, Tashkin DP. Guiding Principles for the Use of Nebulized Long-Acting Beta2-Agonists in Patients with COPD: An Expert Panel Consensus. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 4:7-20. [PMID: 28848907 DOI: 10.15326/jcopdf.4.1.2016.0141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Determining which patients with COPD may benefit from a nebulized long-acting beta2-agonist (LABA) is a challenge in current practice. In the absence of strong clinical guidelines addressing this issue, an expert panel convened to develop guiding principles for the use of nebulized LABA therapy in patients with COPD. This article summarizes these guiding principles and other practical issues discussed during a roundtable meeting.
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Affiliation(s)
- Robert A Wise
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Antonio R Anzueto
- University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, Texas
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Jill A Ohar
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Donald P Tashkin
- David Geffen School of Medicine at the University of California, Los Angeles
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Greenlund KJ, Liu Y, Deokar AJ, Wheaton AG, Croft JB. Association of Chronic Obstructive Pulmonary Disease With Increased Confusion or Memory Loss and Functional Limitations Among Adults in 21 States, 2011 Behavioral Risk Factor Surveillance System. Prev Chronic Dis 2016; 13:E02. [PMID: 26741996 PMCID: PMC4708003 DOI: 10.5888/pcd13.150428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with cognitive impairment, but consequences of this association on a person's functional limitations are unclear. We examined the association between COPD and increased confusion and memory loss (ICML) and functional limitations among adults with COPD. METHODS We studied adults aged 45 years or older in 21 states who participated in the 2011 Behavioral Risk Factor Surveillance System (n = 102,739). Presence of COPD was based on self-reported physician diagnosis. ICML was based on self-report that confusion or memory loss occurred more often or worsened during the prior year. ICML-associated difficulties were defined as giving up household chores and former activities, decreased ability to work or engage in social activities, or needing help from family or friends during the prior year due to ICML. General limitations were defined as needing special equipment as a result of a health condition, having had activity limitations for 2 weeks or more in the prior month, or being unable to work. Multivariable models were adjusted for demographics, health behaviors or conditions, and frequent mental distress. RESULTS COPD was reported by 9.3% of adults. ICML was greater among those with COPD than among those without COPD (25.8% vs 11%; adjusted prevalence ratio [aPR], 1.48; 95% confidence interval [CI], 1.32%-1.66%). People with COPD, either with or without ICML, were more likely than those without COPD to report general functional limitations. Among people reporting ICML, those with COPD were more likely to report interference with work or social activities than those without COPD (aPR, 1.17; 95% CI, 1.01%-1.36%). CONCLUSION Functional limitations were greater among those with COPD than among those without, and ICML may further affect these limitations. Results from our study can inform future studies of self- management and functional limitations for people with COPD.
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Affiliation(s)
- Kurt J Greenlund
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Highway, NE, Mailstop F73, Atlanta GA 30341-3717.
| | - Yong Liu
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Angela J Deokar
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Anne G Wheaton
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Janet B Croft
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
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Dal Negro RW, Bonadiman L, Turco P. Prevalence of different comorbidities in COPD patients by gender and GOLD stage. Multidiscip Respir Med 2015; 10:24. [PMID: 26246895 PMCID: PMC4525744 DOI: 10.1186/s40248-015-0023-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. METHODS The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012-2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. RESULTS At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. CONCLUSIONS All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.
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Affiliation(s)
- R. W. Dal Negro
- />National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, CESFAR, Verona, Italy
- />CEMS, Specialist Medical Centre, Verona, Italy
| | | | - P. Turco
- />Research & Clinical Governance, Verona, Italy
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