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Howard S, Odoi A. Spatial patterns and sociodemographic predictors of chronic obstructive pulmonary disease in Florida. PeerJ 2024; 12:e17771. [PMID: 39104363 PMCID: PMC11299531 DOI: 10.7717/peerj.17771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/27/2024] [Indexed: 08/07/2024] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory respiratory disease that obstructs airflow and decreases lung function and is a leading cause death globally. In the United States (US), the prevalence among adults is 6.2%, but increases with age to 12.8% among those 65 years or older. Florida has one of the largest populations of older adults in the US, accounting for 4.5 million adults 65 years or older. This makes Florida an ideal geographic location for investigating COPD as disease prevalence increases with age. Understanding the geographic disparities in COPD and potential associations between its disparities and environmental factors as well as population characteristics is useful in guiding intervention strategies. Thus, the objectives of this study are to investigate county-level geographic disparities of COPD prevalence in Florida and identify county-level socio-demographic predictors of COPD prevalence. Methods This ecological study was performed in Florida using data obtained from the US Census Bureau, Florida Health CHARTS, and County Health Rankings and Roadmaps. County-level COPD prevalence for 2019 was age-standardized using the direct method and 2020 US population as the standard population. High-prevalence spatial clusters of COPD were identified using Tango's flexible spatial scan statistics. Predictors of county-level COPD prevalence were investigated using multivariable ordinary least squares model built using backwards elimination approach. Multicollinearity of regression coefficients was assessed using variance inflation factor. Shapiro-Wilks, Breusch Pagan, and robust Lagrange Multiplier tests were used to assess for normality, homoskedasticity, and spatial autocorrelation of model residuals, respectively. Results County-level age-adjusted COPD prevalence ranged from 4.7% (Miami-Dade) to 16.9% (Baker and Bradford) with a median prevalence of 9.6%. A total of 6 high-prevalence clusters with prevalence ratios >1.2 were identified. The primary cluster, which was also the largest geographic cluster that included 13 counties, stretched from Nassau County in north-central Florida to Charlotte County in south-central Florida. However, cluster 2 had the highest prevalence ratio (1.68) and included 10 counties in north-central Florida. Together, the primary cluster and cluster 2 covered most of the counties in north-central Florida. Significant predictors of county-level COPD prevalence were county-level percentage of residents with asthma and the percentage of current smokers. Conclusions There is evidence of spatial clusters of COPD prevalence in Florida. These patterns are explained, in part, by differences in distribution of some health behaviors (smoking) and co-morbidities (asthma). This information is important for guiding intervention efforts to address the condition, reduce health disparities, and improve population health.
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Affiliation(s)
- Sara Howard
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | - Agricola Odoi
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
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Tang C, Camp P. Supporting the Respiratory Health of Migrants and Refugees. Clin Chest Med 2023; 44:605-612. [PMID: 37517838 DOI: 10.1016/j.ccm.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Migrants and refugees are at risk of developing acute and chronic respiratory diseases at their destination countries. Yet, people from these populations are also least likely to access care within the current health care system across the world. Although biological, psychological, and social factors play a role in influencing risk of respiratory diseases among these populations, the influences from cultural differences on health behaviors cannot be ignored. Cultural differences are influential in affecting an individual's level of health literacy. Health professionals can contribute to the provision of equitable care to diverse communities through addressing issues related to linguistic and cultural differences.
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Affiliation(s)
- Clarice Tang
- Physiotherapy, Western Sydney University, Sydney, Australia; Allied Health, South Western Sydney Local Health District, Sydney, Australia.
| | - Pat Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Kauhl B, König J, Wolf S. Spatial Distribution of COVID-19 Hospitalizations and Associated Risk Factors in Health Insurance Data Using Bayesian Spatial Modelling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4375. [PMID: 36901384 PMCID: PMC10001453 DOI: 10.3390/ijerph20054375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The onset of COVID-19 across the world has elevated interest in geographic information systems (GIS) for pandemic management. In Germany, however, most spatial analyses remain at the relatively coarse level of counties. In this study, we explored the spatial distribution of COVID-19 hospitalizations in health insurance data of the AOK Nordost health insurance. Additionally, we explored sociodemographic and pre-existing medical conditions associated with hospitalizations for COVID-19. Our results clearly show strong spatial dynamics of COVID-19 hospitalizations. The main risk factors for hospitalization were male sex, being unemployed, foreign citizenship, and living in a nursing home. The main pre-existing diseases associated with hospitalization were certain infectious and parasitic diseases, diseases of the blood and blood-forming organs, endocrine, nutritional and metabolic diseases, diseases of the nervous system, diseases of the circulatory system, diseases of the respiratory system, diseases of the genitourinary and symptoms, and signs and findings not classified elsewhere.
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Affiliation(s)
- Boris Kauhl
- AOK Nordost—Die Gesundheitskasse, Brandenburger Str. 72, 14467 Potsdam, Germany
| | - Jörg König
- AOK Nordost—Die Gesundheitskasse, Brandenburger Str. 72, 14467 Potsdam, Germany
| | - Sandra Wolf
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
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Tziridis K, Friedrich J, Brüeggemann P, Mazurek B, Schulze H. Estimation of Tinnitus-Related Socioeconomic Costs in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610455. [PMID: 36012089 PMCID: PMC9407899 DOI: 10.3390/ijerph191610455] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 05/14/2023]
Abstract
Despite the high prevalence of tinnitus in Germany of nearly 12% of the general population, there have been no systematic studies on the socioeconomic costs for German society caused by tinnitus so far. Here we analyzed data from 258 chronic tinnitus patients-namely tinnitus severity and health utility index (HUI)-and correlated them with their tinnitus-related public health care costs, private expenses, and economic loss due to their tinnitus percept as assessed by questionnaires. We found correlations of the HUI with health care costs and calculated the mean socioeconomic costs per tinnitus patient in Germany. According to our most conservative estimate, these sum up to EUR 4798.91 per year. Of that EUR 2206.95 account for the public health care, EUR 290.45 are carried by the patient privately and the remaining EUR 2301.51 account for economical loss due to sick leave. With a prevalence of 5.5% with at least bothersome tinnitus, this sums up to 21.9 billion Euro per year and with 25.82 sick leave days; tinnitus patients miss work more than double the time of the average German employee (10.9 days). The findings fit within the cost ranges of studies from other European countries and the USA and show that the socioeconomic burden of this disease-like symptom is a global problem. In comparison with the costs of other major chronic diseases in Germany-such as chronic obstructive pulmonary diseases (ca. 16 billion Euro) or diabetes mellitus (ca. 42 billion Euro)-the relevance of the 'symptom' tinnitus for the German social economy becomes even more obvious.
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Affiliation(s)
- Konstantin Tziridis
- Experimental Otolaryngology, University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Jana Friedrich
- Experimental Otolaryngology, University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Petra Brüeggemann
- Tinnitus Center, Charité University Medicine Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité University Medicine Berlin, Luisenstrasse 13, 10117 Berlin, Germany
| | - Holger Schulze
- Experimental Otolaryngology, University of Erlangen-Nuremberg, Waldstrasse 1, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-8543045; Fax: +49-9131-8534778
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Johnson O, Gatheral T, Knight J, Giorgi E. A modelling framework for developing early warning systems of COPD emergency admissions. Spat Spatiotemporal Epidemiol 2021; 36:100392. [PMID: 33509425 DOI: 10.1016/j.sste.2020.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality worldwide and is a major contributor to the number of emergency admissions in the UK. We introduce a modelling framework for the development of early warning systems for COPD emergency admissions. We analyse the number of COPD emergency admissions using a Poisson generalised linear mixed model. We group risk factors into three main groups, namely pollution, weather and deprivation. We then carry out variable selection within each of the three domains of COPD risk. Based on a threshold of incidence rate, we then identify the model giving the highest sensitivity and specificity through the use of exceedance probabilities. The developed modelling framework provides a principled likelihood-based approach for detecting the exceedance of thresholds in COPD emergency admissions. Our results indicate that socio-economic risk factors are key to enhance the predictive power of the model.
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Affiliation(s)
- Olatunji Johnson
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK.
| | - Tim Gatheral
- Respiratory Medicine, Royal Lancaster Infirmary, Lancaster, UK
| | - Jo Knight
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - Emanuele Giorgi
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
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Akmatov MK, Ermakova T, Holstiege J, Steffen A, von Stillfried D, Bätzing J. Comorbidity profile of patients with concurrent diagnoses of asthma and COPD in Germany. Sci Rep 2020; 10:17945. [PMID: 33087813 PMCID: PMC7578650 DOI: 10.1038/s41598-020-74966-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to estimate the prevalence of concurrent diagnoses of asthma/COPD and examine its full spectrum of comorbid disorders in Germany. We used nationwide outpatient claims data comprising diagnoses of all statutory health insurees (40+ years) in 2017 (N = 40,477,745). The ICD-10 codes J44 (COPD) and J45 (asthma) were used to identify patients. The odds of 1,060 comorbid disorders were examined in a case-control study design. Of all insurees, 4,632,295 (11%) were diagnosed with either asthma or COPD. Of them, 43% had asthma only, 44% COPD only and 13% both diseases. The prevalence of concurrent asthma/COPD was 1.5% with a slightly higher estimate among females than males (1.6% vs. 1.4%) and constant increase by age in both sexes. Comorbid disorders were very common among these patients. 31 disorders were associated with a strong effect size (odds ratio > 10), including other respiratory diseases, but also bacterial (e.g., mycobacteria, including tuberculosis) and fungal infections (e.g., sporotrichosis and aspergillosis). Patients with concurrent asthma/COPD suffer from comorbid disorders involving various body systems, which points to the need of a multidisciplinary care approach. Regular screening for common comorbid disorders may result in better clinical course and prognosis as well as improvement of patients' quality of life.
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Affiliation(s)
- Manas K Akmatov
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
| | - Tatiana Ermakova
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
- Weizenbaum Institute for the Networked Society, Berlin, Germany
- Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Annika Steffen
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | | | - Jörg Bätzing
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
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Sharma AK, Kalra OP, Saini NK, Kelkar H. Pilot Study of Chronic Obstructive Pulmonary Disease in an Industrial Town in India. J Health Pollut 2019; 9:190304. [PMID: 30931164 PMCID: PMC6421949 DOI: 10.5696/2156-9614-9.21.190304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The burden of chronic obstructive pulmonary disease (COPD) in India is not well understood. Due to geographical and environmental heterogeneity, the epidemiological profile of COPD may not be uniform across the country. Studies carried out in small geographical areas can help to determine the prevalence and risk factors of COPD. OBJECTIVES The present study was conducted in one city in northwest India in order to calculate prevalence in small geographically determined areas within the city as well as across socio-economic strata and adjoining neighborhoods. METHODS The present study was conducted in Ludhiana, an industrial town in Punjab, India. Residential colonies were identified in an industrial and nonindustrial area and all households were screened for COPD using the Global Initiative for Chronic Obstructive Lung Disease criteria and confirmed by spirometry. Information about exposure to possible risk factors was also collected from suspected cases of COPD. Cases were mapped on a digital map of the city and hotspots were identified. RESULTS Fifty-six cases of COPD were detected. More than half (71%) were in the industrial area. The overall prevalence rate of COPD in the city was 3.17 per 1 000. The highest prevalence (5.6-9.4 per thousand) was observed in the colonies of the industrial area. All surveyed colonies in the nonindustrial area showed a low prevalence (0.0 to 0.9 per thousand). CONCLUSIONS Hotspots were located in the industrial area and there was no such aggregation in the nonindustrial area. This suggests a potential association of industrial air pollutants with COPD. A strength of the present study is that it provides important baseline data. However, the study was limited, as it did not show a temporal association of exposure to air pollution and smoking with COPD. PARTICIPANT CONSENT Obtained. ETHICS APPROVAL The study was approved by the Institutional Ethics Committee for Human Research of the University College of Medical Sciences, Delhi, India. INFORMED CONSENT Obtained. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Arun Kumar Sharma
- Department of Community Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Om Prakash Kalra
- Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Narinder Kumar Saini
- Department of Community Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Harshita Kelkar
- Department of Community Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Koverech A, Soldati V, Polidori V, Pomes LM, Lionetto L, Capi M, Negro A, Simmaco M, Martelletti P. Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081634. [PMID: 30072608 PMCID: PMC6122067 DOI: 10.3390/ijerph15081634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
The ageing of the world population has resulted in an increase in the number of older patients with multimorbid conditions receiving multiple therapies. This emerging clinical scenario poses new challenges, which are mostly related to the increased incidence of adverse effects. This translates into poor clinical care, reduced cost-effectiveness of drug therapies, and social isolation of multimorbid patients due to reduced autonomy. A strategy to address these emerging challenges could involve the personalization of therapies based on the clinical, molecular, and genetic characterization of multimorbid patients. Anticoagulation therapy is a feasible model to implement personalized medicine since it generally involves older multimorbid patients receiving multiple drugs. In this study, in patients with atrial fibrillation, the use of the new generation of anticoagulation therapy, i.e., direct oral anti-coagulants (DOACs), is based on a preliminary assessment of the molecular targets of DOACS and any possible drug⁻drug interactions. Then, the genetic polymorphism of enzymes metabolizing DOACs is studied. After DOAC prescription, its circulating levels are measured. Clinical data are being collected to assess whether this personalized approach improves the safety and efficacy profiles of anticoagulation therapy using DOACs, thereby reducing the costs of healthcare for ageing multimorbid patients.
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Affiliation(s)
- Angela Koverech
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Universitaria S. Andrea, via di Grottarossa 1035/1039, 00189 Rome, Italy.
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Roma, Italy.
| | - Valeriano Soldati
- NESMOS Department, S. Andrea Hospital, University of Rome Sapienza, 00185 Rome, Italy.
| | - Vittoria Polidori
- NESMOS Department, S. Andrea Hospital, University of Rome Sapienza, 00185 Rome, Italy.
| | - Leda Marina Pomes
- Residency Program in Laboratory Medicine, Gabriele d'Annunzio University, 66100 Chieti, Italy.
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI-IRCCS, 00168 Rome, Italy.
| | - Matilde Capi
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, via di Grottarossa 1035/1039, 00189 Rome, Italy.
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Universitaria S. Andrea, via di Grottarossa 1035/1039, 00189 Rome, Italy.
| | - Maurizio Simmaco
- NESMOS Department, S. Andrea Hospital, University of Rome Sapienza, 00185 Rome, Italy.
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Universitaria S. Andrea, via di Grottarossa 1035/1039, 00189 Rome, Italy.
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