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Jo YS, Han S, Lee D, Min KH, Park SJ, Yoon HK, Lee WY, Yoo KH, Jung KS, Rhee CK. Development of a daily predictive model for the exacerbation of chronic obstructive pulmonary disease. Sci Rep 2023; 13:18669. [PMID: 37907619 PMCID: PMC10618439 DOI: 10.1038/s41598-023-45835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
Acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) compromises health status; it increases disease progression and the risk of future exacerbations. We aimed to develop a model to predict COPD exacerbation. We merged the Korean COPD subgroup study (KOCOSS) dataset with nationwide medical claims data, information regarding weather, air pollution, and epidemic respiratory virus data. The Korean National Health and Nutrition Examination Survey (KNHANES) dataset was used for validation. Several machine learning methods were employed to increase the predictive power. The development dataset consisted of 590 COPD patients enrolled in the KOCOSS cohort; these were randomly divided into training and internal validation subsets on the basis of the individual claims data. We selected demographic and spirometry data, medications for COPD and hospital visit for AE, air pollution data and meteorological data, and influenza virus data as contributing factors for the final model. Six machine learning and logistic regression tools were used to evaluate the performance of the model. A light gradient boosted machine (LGBM) afforded the best predictive power with an area under the curve (AUC) of 0.935 and an F1 score of 0.653. Similar favorable predictive performance was observed for the 2151 individuals in the external validation dataset. Daily prediction of the COPD exacerbation risk may help patients to rapidly assess their risk of exacerbation and will guide them to take appropriate intervention in advance. This might lead to reduction of the personal and socioeconomic burdens associated with exacerbation.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Solji Han
- Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea
| | - Daeun Lee
- Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seoung Ju Park
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Weiss J, Raghu VK, Bontempi D, Christiani DC, Mak RH, Lu MT, Aerts HJWL. Deep learning to estimate lung disease mortality from chest radiographs. Nat Commun 2023; 14:2797. [PMID: 37193717 DOI: 10.1038/s41467-023-37758-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/29/2023] [Indexed: 05/18/2023] Open
Abstract
Prevention and management of chronic lung diseases (asthma, lung cancer, etc.) are of great importance. While tests are available for reliable diagnosis, accurate identification of those who will develop severe morbidity/mortality is currently limited. Here, we developed a deep learning model, CXR Lung-Risk, to predict the risk of lung disease mortality from a chest x-ray. The model was trained using 147,497 x-ray images of 40,643 individuals and tested in three independent cohorts comprising 15,976 individuals. We found that CXR Lung-Risk showed a graded association with lung disease mortality after adjustment for risk factors, including age, smoking, and radiologic findings (Hazard ratios up to 11.86 [8.64-16.27]; p < 0.001). Adding CXR Lung-Risk to a multivariable model improved estimates of lung disease mortality in all cohorts. Our results demonstrate that deep learning can identify individuals at risk of lung disease mortality on easily obtainable x-rays, which may improve personalized prevention and treatment strategies.
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Affiliation(s)
- Jakob Weiss
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street and 450 Brookline Avenue, Boston, MA, 02115, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, 02114, Boston, USA
| | - Vineet K Raghu
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, 02114, Boston, USA
| | - Dennis Bontempi
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Boston, MA, 02115, USA
- Pulmonary and Critical Care Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Raymond H Mak
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street and 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Michael T Lu
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, 02114, Boston, USA
| | - Hugo J W L Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street and 450 Brookline Avenue, Boston, MA, 02115, USA.
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, 02114, Boston, USA.
- Pulmonary and Critical Care Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Bonomo M, Hermsen MG, Kaskovich S, Hemmrich MJ, Rojas JC, Carey KA, Venable LR, Churpek MM, Press VG. Using Machine Learning to Predict Likelihood and Cause of Readmission After Hospitalization for Chronic Obstructive Pulmonary Disease Exacerbation. Int J Chron Obstruct Pulmon Dis 2022; 17:2701-2709. [PMID: 36299799 PMCID: PMC9590342 DOI: 10.2147/copd.s379700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital readmissions. Few existing tools use electronic health record (EHR) data to forecast patients’ readmission risk during index hospitalizations. Objective We used machine learning and in-hospital data to model 90-day risk for and cause of readmission among inpatients with acute exacerbations of COPD (AE-COPD). Design Retrospective cohort study. Participants Adult patients admitted for AE-COPD at the University of Chicago Medicine between November 7, 2008 and December 31, 2018 meeting International Classification of Diseases (ICD)-9 or −10 criteria consistent with AE-COPD were included. Methods Random forest models were fit to predict readmission risk and respiratory-related readmission cause. Predictor variables included demographics, comorbidities, and EHR data from patients’ index hospital stays. Models were derived on 70% of observations and validated on a 30% holdout set. Performance of the readmission risk model was compared to that of the HOSPITAL score. Results Among 3238 patients admitted for AE-COPD, 1103 patients were readmitted within 90 days. Of the readmission causes, 61% (n = 672) were respiratory-related and COPD (n = 452) was the most common. Our readmission risk model had a significantly higher area under the receiver operating characteristic curve (AUROC) (0.69 [0.66, 0.73]) compared to the HOSPITAL score (0.63 [0.59, 0.67]; p = 0.002). The respiratory-related readmission cause model had an AUROC of 0.73 [0.68, 0.79]. Conclusion Our models improve on current tools by predicting 90-day readmission risk and cause at the time of discharge from index admissions for AE-COPD. These models could be used to identify patients at higher risk of readmission and direct tailored post-discharge transition of care interventions that lower readmission risk.
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Affiliation(s)
- Matthew Bonomo
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael G Hermsen
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Samuel Kaskovich
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Juan C Rojas
- Department of Medicine, Section of Pulmonary/Critical Care, University of Chicago, Chicago, IL, USA
| | - Kyle A Carey
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Laura Ruth Venable
- Department of Medicine, Section of Hospitalist Medicine, University of Chicago, Chicago, IL, USA
| | - Matthew M Churpek
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Valerie G Press
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA,Department of Pediatrics, Section of Academic Pediatrics, University of Chicago, Chicago, IL, USA,Correspondence: Valerie G Press, University of Chicago, 5841 S Maryland, MC 2007, Chicago, IL, 60637, USA, Tel +773-702-5170, Email
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Olortegui-Rodriguez JJ, Soriano-Moreno DR, Benites-Bullón A, Pelayo-Luis PP, Huaringa-Marcelo J. Prevalence and incidence of chronic obstructive pulmonary disease in Latin America and the Caribbean: a systematic review and meta-analysis. BMC Pulm Med 2022; 22:273. [PMID: 35842603 PMCID: PMC9288210 DOI: 10.1186/s12890-022-02067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) remains one of the leading causes of morbidity and mortality worldwide, and its epidemiology in Latin America and the Caribbean is not well described. The aim of this study was to evaluate the prevalence and incidence of COPD in Latin America and the Caribbean. Methods We searched systematically in Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed, and Embase from 2010 to 2021. Studies assessing the prevalence and incidence of COPD according to the GOLD classification were included. The overall prevalence of COPD was calculated as a function of the general population using a random-effects model. Results 20 studies (19 cross-sectional and 1 cohort) met the inclusion criteria. The prevalence of COPD in the general population older than 35 years was 8.9%. The prevalence in men was 13.7% and in women 6.7%. The prevalence in smokers and ex-smokers was 24.3%. The incidence in the general population of COPD according to one study was 3.4% at 9 years of follow-up.
Conclusions COPD is prevalent in Latin America, especially in men and in smokers and ex-smokers. Further prevalence and incidence studies in the general population are needed, as well as health policies and strategies to address the disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02067-y.
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Affiliation(s)
- Juan J Olortegui-Rodriguez
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - David R Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru.
| | - Alejandro Benites-Bullón
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Pilar P Pelayo-Luis
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima, Peru
| | - Jorge Huaringa-Marcelo
- Facultad de Medicina Humana, Universidad Científica del Sur, Lima, Peru.,Hospital Nacional Arzobispo Loayza, Lima, Peru
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Li M, Cheng K, Ku K, Li J, Hu H, Ung COL. Factors Influencing the Length of Hospital Stay Among Patients with Chronic Obstructive Pulmonary Disease (COPD) in Macao Population: A Retrospective Study of Inpatient Health Record. Int J Chron Obstruct Pulmon Dis 2021; 16:1677-1685. [PMID: 34135579 PMCID: PMC8200153 DOI: 10.2147/copd.s307164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aims to identify the effects of patient and clinical therapy factors on the length of hospital stay (LOS) for admission due to chronic obstructive pulmonary disease (COPD) in Macao. Patients and Methods Health record of patients with COPD admitted to Kiang Wu Hospital from January 2017 to December 2019 was retrospectively analyzed. Demographic information, blood test results, clinical therapies, and LOS were described and analyzed by multivariable regression. Results A total of 1116 admissions were included with the average LOS being 12.28 (±9.23) days. Among them, 735 (66.6%) were male with mean age 79.42 (±10.35) years old, 697 were current or previous smokers (62.5%), and 360 (32.2%) had 3 or more comorbidities. During hospitalization, the most common treatments received were oxygen therapy (n=991,88.8%), antibiotics (n=828,74.2%), and systemic steroids (n=596,53.4%); only 120 (10.8%) had pulmonary rehabilitation (PR) and 128 (11.5%) received noninvasive ventilation (NIV). Inhaled medications were used during nearly 95% of hospitalization cases, while 2 and 3 types of inhaled medications were used during 230 (20.6%) and 582 (52.2%) hospitalization cases, respectively. Patient factors including age (B=0.178, 95% CI:0.535–1.072), being female (B=−1.147, 95% CI:-0.138–0.056), being current (B=−0.086, 95% CI:-0.124–0.018) or previous smoker (B=0.072, 95% CI:0.004–0.087), having 1, 2, 3 and over 3 comorbidities (B=0.126, 95% CI:0.034–0.147; B=0.125, 95% CI:0.031–0.144; B=0.116, 95% CI:0.028–0.146, B=0.090, 95% CI:0.021–0.166) and having low hemoglobin level (B=−0.118, 95% CI:-0.629- −0.214) exhibited significant associations with LOS. The use of NIV (B=0.080, 95% CI:0.022–0.138), pulmonary rehabilitation (B=0.269, 95% CI:0.212–0.327), two and three types of inhaled medications (B=0.109, 95% CI:0.003–0.166, B=0.255, 95% CI:0.083–0.237) were significantly associated with longer LOS (P<0.05). Conclusion NIV, PR and combined inhaled medications, which are often used for AECOPD, are the main clinical therapies associated with longer LOS in Macao. Smoking cessation, early treatments of comorbidities may be crucial to avoiding AECOPD and reducing LOS and disease burden.
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Affiliation(s)
- Meng Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Kun Cheng
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Keisun Ku
- Internal Medicine Department, Kiang Wu Hospital, Macao SAR, China
| | - Junlei Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao SAR, China
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Zhang Y, Wang Z, Cao Y, Zhang L, Wang G, Dong F, Deng R, Guo B, Zeng L, Wang P, Dai R, Ran Y, Lyu W, Miao P, Su S. The effect of consecutive ambient air pollution on the hospital admission from chronic obstructive pulmonary disease in the Chengdu region, China. AIR QUALITY, ATMOSPHERE, & HEALTH 2021; 14:1049-1061. [PMID: 33758631 PMCID: PMC7971392 DOI: 10.1007/s11869-021-00998-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/11/2021] [Indexed: 06/02/2023]
Abstract
Hospitalisation risks for chronic obstructive pulmonary disease (COPD) have been attributed to ambient air pollution worldwide. However, a rise in COPD hospitalisations may indicate a considerable increase in fatality rate in public health. The current study focuses on the association between consecutive ambient air pollution (CAAP) and COPD hospitalisation to offer predictable early guidance towards estimates of COPD hospital admissions in the event of consecutive exposure to air pollution. Big data analytics were collected from 3-year time series recordings (from 2015 to 2017) of both air data and COPD hospitalisation data in the Chengdu region in China. Based on the combined effects of CAAP and unit increase in air pollutant concentrations, a quasi-Poisson regression model was established, which revealed the association between CAAP and estimated COPD admissions. The results show the dynamics and outbreaks in the variations in COPD admissions in response to CAAP. Cross-validation and mean squared error (MSE) are applied to validate the goodness of fit. In both short-term and long-term air pollution exposures, Z test outcomes show that the COPD hospitalisation risk is greater for men than for women; similarly, the occurrence of COPD hospital admissions in the group of elderly people (> 65 years old) is significantly larger than that in lower age groups. The time lag between the air quality and COPD hospitalisation is also investigated, and a peak of COPD hospitalisation risk is found to lag 2 days for air quality index (AQI) and PM10, and 1 day for PM2.5. The big data-based predictive paradigm would be a measure for the early detection of a public health event in post-COVID-19. The study findings can also provide guidance for COPD admissions in the event of consecutive exposure to air pollution in the Chengdu region.
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Affiliation(s)
- Yi Zhang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Ziyue Wang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Yu Cao
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Lifu Zhang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Guan Wang
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Fangjie Dong
- The Centre for Health Statistics and Information National Health Commission of the P.R. of China, Beijing, 100000 China
| | - Ren Deng
- Health Information Center of Sichuan Province, Chengdu, 611731 China
| | - Baogen Guo
- TCM Hospital of Shuangliu District, Chengdu, 610200 China
| | - Li Zeng
- Longchang People’s Hospital, Neijiang, 642150 China
| | - Peng Wang
- The People’s Hospital of Weiyuan, Weiyuan, 642450 China
| | - Ruimei Dai
- Sichuan Post and Telecommunication College, Chengdu, 610067 China
| | - Yu Ran
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Wenyi Lyu
- The School of Aeronautics and Astronautics, University of Electronic Science and Technology of China, Chengdu, 611731 China
- Aircraft Swarm Intelligent Sensing Cooperative Control Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, 611731 China
| | - Peiwen Miao
- Sichuan Agricultural University, Chengdu, 625014 China
| | - Steven Su
- The Biomedical Engineering School, University of Technology Sydney, Ultimo, NSW 2007 Australia
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Jo YS, Rhee CK, Kim KJ, Yoo KH, Park YB. Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2020; 14:1753466620961688. [PMID: 33070701 PMCID: PMC7580139 DOI: 10.1177/1753466620961688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background and aims: Patients discharged after treatment for acute exacerbation of chronic obstructive pulmonary disease (COPD) are at high risk for readmission. We aimed to identify the prevalence and risk factors for readmission. Methods: We included 16,105 patients who had claimed their medical expenses from 1 May 2014 to 1 May 2016 after discharge from any medical facility in Korea, following treatment for acute exacerbation of COPD. We analysed the potential risk factors for readmission within 30 days of discharge. Results: Readmission rate was 26.4% (3989 patients among 15,101 patients) and over 50% of readmissions occurred within 10 days of discharge. Approximately 57% of readmissions occurred due to respiratory causes. Major causes of readmission were COPD (27%), pneumonia (14.2%), and lung cancer (7.1%), in that order. Patients who were readmitted were male, had more comorbidities and were less frequently admitted to tertiary hospitals than those who were not readmitted. Risk factors for readmission within 30 days of discharge were male sex, medical aid coverage, longer hospital stay, longer duration of systemic steroid use during hospital stay, high comorbid condition index, and discharge to skilled nursing facility. Conclusion: Readmission occurred in approximately one-quarter of patients, and was associated with patient-related and clinical factors. Using these results, we can identify high-risk patients for readmission and precautions are needed to be taken before deciding on a discharge plan. Further research is needed to develop accurate tools for predicting the risk of readmission before discharge, and development and evaluation of an effective care programme for COPD patients are necessary. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.,Lung Research Institute of Hallym University College of Medicine, Chuncheon, South Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea
| | - Kyung Joo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Division of Pulmonary and Allergy Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong-Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Gangdong-gu, Seoul 05355, Korea.,Lung Research Institute of Hallym University College of Medicine, Chuncheon, South Korea
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Choi HS, Yang DW, Rhee CK, Yoon HK, Lee JH, Lim SY, Kim YI, Yoo KH, Hwang YI, Lee SH, Park YB. The health-related quality-of-life of chronic obstructive pulmonary disease patients and disease-related indirect burdens. Korean J Intern Med 2020; 35:1136-1144. [PMID: 32066224 PMCID: PMC7487298 DOI: 10.3904/kjim.2018.398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIMS Many chronic obstructive pulmonary disease (COPD) patients have physical limitations. We investigated EuroQol five-dimensions five-level (EQ-5D-5L) of COPD patients to assess quality of life, and assessed indirect burden including time expenditure to visit doctor, home care rate, and caregiver related burden. METHODS We recruited 355 COPD patients according to severity of airflow limitation that severity was set at 10% mild, 40% moderate, 30% severe, and 20% very severe in two primary and 11 secondary/tertiary hospitals. Eligible patients were aged ≥ 40 years, who have been diagnosed with COPD for more than 1 year. Patients were recruited between June 2015 and October 2016. RESULTS The quality of life tended to decline with age, from mild to very severe impairment, as revealed by the EQ-5D-5L scores and the EQ visual analog scale. Family caregivers accompanied 22.6% of patients who visited outpatient clinics, and 25% of stage IV COPD patients. During emergency visits and hospitalization, this figure increased to > 60%. The home care rates were 28.5% for stage I patients, and 34.4, 31.8, and 52% for stage II to IV patients, respectively. The percentage of caregivers who stopped working was 13.6%. The EQ-5D index was strongly associated with the dyspnea scale (r = -0.64, p < 0.001). The average required time to see a doctor and visit the pharmacy was 154 minutes. CONCLUSION In patients with COPD, the EQ-5D index decreased and disease-related home caregiving increased with airflow limitation. We considered the caregiver- related burden when making a strategy for COPD management.
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Affiliation(s)
- Hye Sook Choi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong-Wook Yang
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hwa Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong Yong Lim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu-Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
- Correspondence to Yong Bum Park, M.D. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea Tel: +82-2-2225-2754, Fax: +82-2-2224-2569, E-mail:
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9
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Abdulsalim S, Unnikrishnan MK, Manu MK, Alsahali S, Alrasheedy AA, Martin AP, Godman B, Alfadl AA. Impact of a Clinical Pharmacist Intervention on Medicine Costs in Patients with Chronic Obstructive Pulmonary Disease in India. PHARMACOECONOMICS - OPEN 2020; 4:331-342. [PMID: 31368087 PMCID: PMC7248138 DOI: 10.1007/s41669-019-0172-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in low- and middle-income countries (LMICs) such as India. Medicine costs are a key issue in LMICs, with typically high patient co-payments. In addition, pharmacists are underutilised in LMICs, including India. However, pharmacist-led educational interventions may improve the care of patients with COPD, as well as reduce medicine costs. Consequently, the objective of this study was to assess the effectiveness of a pharmacist-led intervention in reducing medicine costs. METHODOLOGY We assessed the impact of a pharmacist intervention on direct medicine costs in COPD patients (medicine costs and pharmacist time) in a randomised controlled study involving an intervention and control group, conducted at a tertiary care teaching hospital in India. RESULTS The 6-monthly cost of medicines at baseline increased with disease severity, from a maximum of US$29.46 for those with mild COPD to US$63.28 for those with very severe COPD. Substantial savings in medical costs were achieved with the pharmacist-led programme, to a maximum of US$20.49 over 6 months for very severe patients. This equates to a reduction of 30.6% in medicine costs (p < 0.001), reduced to 26.1% when pharmacists' time (US$3.00/patient) was included. CONCLUSION There could be a key role for pharmacists as educators for COPD patients in LMICs, to improve care and reduce costs, including patient co-payments.
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Affiliation(s)
- Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- MCOPS, Manipal Academy of Higher Education, Manipal, India
| | | | - Mohan K. Manu
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Saud Alsahali
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- HCD Economics, The Innovation Centre, Daresbury, WA4 4FS UK
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM Penang, Malaysia
| | - Abubakr A. Alfadl
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
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10
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Schofield SJ, Woods A, Szram J, Newman Taylor AJ, Cullinan P. Chronic Obstructive Pulmonary Disease and Breathlessness in Older Workers Predict Economic Inactivity. A Prospective Cohort Study. Am J Respir Crit Care Med 2020; 200:1228-1233. [PMID: 31348686 DOI: 10.1164/rccm.201902-0297oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: There is an aspiration to retain increasing numbers of older workers in employment, and strategies to achieve this need to make provision for the increasing prevalence of chronic diseases with age. There is a consistent body of cross-sectional evidence that suggests that patients with chronic obstructive pulmonary disease are more likely to have adverse employment outcomes.Objectives: We report the findings of the first longitudinal study of this issue.Methods: We recruited full-time employed men and women in their 50s and followed them for a period of 18 months; we examined, after adjustment for potential confounders, the associations between breathlessness and airway obstruction at baseline and loss of employment in the intervening period.Measurements and Main Results: Among participants responding to the follow-up questionnaire (1,656 of 1,773 [93%]), the majority (78.5%) continued in full-time employment, but 10.6% were in part-time employment and 10.9% were no longer in paid employment. The adjusted risk of loss of employment was significantly increased for those with moderate or severe chronic obstructive pulmonary disease (risk ratio, 2.89; 95% confidence interval, 1.80-4.65) or breathlessness (risk ratio, 3.07; 95% confidence interval, 2.16-4.37) at baseline. There was no evident modification by sex or by manual/nonmanual work.Conclusions: Airway obstruction and breathlessness are independently associated with premature loss from the workforce in older workers; these observations provide strong support to the available cross-sectional evidence and suggest that interventions to help those with chronic obstructive pulmonary disease who wish to remain in work need to be tested.
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Affiliation(s)
- Susie J Schofield
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Annette Woods
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Joanna Szram
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.,Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Anthony J Newman Taylor
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and
| | - Paul Cullinan
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; and.,Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
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11
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Lindström I, Pallasaho P, Remes J, Vasankari T, Heliövaara M. Does lung function predict the risk of disability pension? An 11-year register-based follow-up study. BMC Public Health 2020; 20:165. [PMID: 32013933 PMCID: PMC6998269 DOI: 10.1186/s12889-020-8277-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Spirometry is widely used in medical surveillance in occupational health and as a diagnostic test for obstructive and restrictive lung disease. We evaluated the effect of spirometry parameters on the risk of all-cause disability pension in a follow-up study of an occupationally active general population-based cohort. Methods We measured the pulmonary function of 3386 currently working participants of the Health 2000 Survey in the clinical phase at baseline using spirometry. We obtained the retirement events of the cohort from the nationwide register for 2000–2011. Cox proportional hazards models were used to determine disability pensions. Results At baseline, we identified 111 (3.3%) participants with obstructive spirometry, 95 (2.8%) with restrictive spirometry, and 3180 controls without restriction or obstruction. The age, sex, educational level, body-mass index, co-morbidities (1 or ≥ 2), and the smoking-adjusted hazard ratio of disability pension was 1.07 (95% confidence interval, CI 0.64–1.78) for those with obstructive spirometry, and 1.44 (95% CI 0.89–2.32) for those with restrictive spirometry. As continuous variables, and divided into quartiles, the risk of the lowest quartile of forced ventilation capacity (FVC)% of predicted was 1.49 (95%CI 1.10–2.01) and forced expiratory volume in one second (FEV1)% of predicted 1.66 (95%CI: 1.23–2.24) in comparison to the highest quartile in the adjusted models. Conclusions Obstructive or restrictive spirometry did not predict disability pension when dichotomized classified variables (normal compared to abnormal) were used. As continuous variables and when divided into quartiles, lower lung volumes showed an increase in the risk of disability pension. Physicians should take this into account when they use spirometry as a prognostic factor of work disability.
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Affiliation(s)
- Irmeli Lindström
- Occupational Medicine, Finnish Institute of Occupational Health, Topeliuksenkatu 41 B, 00250, Helsinki, Finland.
| | | | - Jouko Remes
- Statistical Services Team, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuula Vasankari
- Finnish Lung Health Association (Filha ry), Helsinki, Finland.,Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
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12
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Is It Time to Move on from Identifying Risk Factors for 30-Day Chronic Obstructive Pulmonary Disease Readmission? A Call for Risk Prediction Tools. Ann Am Thorac Soc 2019; 15:801-803. [PMID: 29957037 DOI: 10.1513/annalsats.201804-246ed] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Insights about the economic impact of chronic obstructive pulmonary disease readmissions post implementation of the hospital readmission reduction program. Curr Opin Pulm Med 2019; 24:138-146. [PMID: 29210750 DOI: 10.1097/mcp.0000000000000454] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) affects over 12 million adults in the United States and is the third leading cause of 30-day readmissions. COPD is costly with almost $50 billion in direct costs annually. Total COPD costs can be up to double the identified direct costs because of comorbid disease and numerous indirect costs such as absenteeism. Acute exacerbations of COPD (AECOPD) are responsible for up to 70% of COPD-related healthcare costs; hospital readmissions alone account for over $15 billion annually. In this review, we aim to describe insights about the economic impact of COPD readmissions based on articles published over the last 18 months. RECENT FINDINGS Interventions aimed at reducing readmission, particularly those using interdisciplinary teams with bundled care interventions, were uniformly successful at improving the quality of care provided and demonstrating improved process measures. However, success at reducing readmissions and cost savings based on these interventions varied across the studies. SUMMARY The literature to date points to factors and conditions that may place patients at higher risk of readmissions and may lead to higher costs. Interventions aimed at reducing readmissions after index admissions for AECOPD have demonstrated variable results. Most interventions did not reflect cost-based analyses.
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14
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Criner GJ, Jacobs MR, Zhao H, Marchetti N. Effects of Roflumilast on Rehospitalization and Mortality in Patients. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2018; 6:74-85. [PMID: 30775426 PMCID: PMC6373589 DOI: 10.15326/jcopdf.6.1.2018.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation portends the greatest risk of rehospitalization and mortality. Treatments that prevent hospitalizations could significantly lessen COPD morbidity and mortality. Methods: We performed a prospective, randomized, double-blind, placebo-controlled study of roflumilast 500 ug daily versus placebo in patients hospitalized for acute COPD exacerbation. Primary outcome was time to all-cause mortality or non-elective rehospitalization at 180 days post-randomization. Secondary outcomes were death or hospitalization from a respiratory cause, quality of life, change in health status, forced expiratory volume in 1 second (FEV1) and roflumilast tolerance. Results: A total of 64 patients with moderate to severe COPD (FEV1, 37.6 ± 16.4% predicted; 61% female, 61.6 ± 7.9 years old) were assigned to roflumilast or placebo. No deaths occurred in the follow-up period. There was no difference in the time to first readmission between the roflumilast and placebo groups (46.1 days versus 47.3 days respectively, p=0.93). There were 29 and 30 readmissions in the roflumilast and placebo groups, respectively (p=0.47). The St George's Respiratory Questionnaire (SGRQ) decreased 10.8 points and 7.8 points in the roflumilast and placebo groups, respectively and were not different. EuroQuality of Life Five Dimension scale (EQ5D) scores improved, but not significantly in either group. Weight loss and nausea were more common with roflumilast but not different from placebo. Change in glycosylated hemoglobin percentage (HgbA1C%) was not different between groups. Sub-analysis for the impact of chronic bronchitis did not affect outcomes. Conclusion: In this pilot study conducted in patients hospitalized with an exacerbation of COPD, roflumilast did not affect time to all-cause rehospitalization, quality of life, FEV1 or any other measured parameter.
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Affiliation(s)
- Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Michael R. Jacobs
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine and Temple School of Pharmacy, Temple University, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
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15
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Abstract
Many unmet needs still remain in the assessment and treatment of patients with chronic obstructive pulmonary disease (COPD), particularly in relation to its under- and misdiagnosis, which lead to under- and mistreatment. This paucity of knowledge about the importance and presence of COPD, as well as its treatment, is seen among patients and carers as well as health care providers. This review considers areas of key educational need, including the clinical characteristics of COPD; factors that contribute to the disease, effective diagnosis, and clinical management of patients; and the implementation of treatment guidelines. As COPD remains the third most frequent cause of death in the world, researchers must continue to expand the scope and reach of their efforts to improve outcomes of this debilitating disease.
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16
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Shin SH, Park J, Cho J, Sin DD, Lee H, Park HY. Severity of Airflow Obstruction and Work Loss in a Nationwide Population of Working Age. Sci Rep 2018; 8:9674. [PMID: 29946117 PMCID: PMC6018711 DOI: 10.1038/s41598-018-27999-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/14/2018] [Indexed: 12/17/2022] Open
Abstract
The impact of COPD severity on labor force participation and work loss is not well known. This study aimed to describe the characteristics of occupations and to evaluate the reason for work loss based on the severity of airflow obstruction (AO). We performed a cross-sectional study using data from the Korean National Health and Nutrition Examination Survey V-VI. We identified 9,901 people aged 40 to 60 years who had normal or AO in spirometry test results. AO was defined as a pre-bronchodilator forced expiratory volume in 1 second/forced vital capacity <70%. AO was present in 7.6% of the subjects, and 81.5%, 82.9%, and 71.6% of subjects with mild, moderate, and severe-to-very severe AO were in the labor force, respectively. Multivariable analyses revealed that severe-to-very severe AO subjects were more likely to have precarious job (adjusted OR = 4.71, 95% CI = 1.70-13.06) and cite health-related problem as the reason for not being in the labor force (adjusted OR = 3.38, 95% CI = 1.03-11.02). Overall, AO was not associated with any significant changes in labor force participation. However, subjects with severe-to-very severe disease were more likely to drop out of the labor force owing to their health-related problems.
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Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Don D Sin
- Respiratory Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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17
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Ghimire A, Han MK. The Exacerbation Conundrum. Arch Bronconeumol 2018; 55:5-6. [PMID: 29789173 DOI: 10.1016/j.arbres.2018.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Anil Ghimire
- Division of Pulmonary & Critical Care, SUNY Upstate Medical University, United States
| | - MeiLan K Han
- Division of Pulmonary & Critical Care, University of Michigan, United States.
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18
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Malmartel A, Eap D, Ghasarossian C. [Spotting the GLObalRIsk of severe outcomes in undiagnosed COPD patients (GLORI-COPD)]. Rev Mal Respir 2018; 35:347-352. [PMID: 29602483 DOI: 10.1016/j.rmr.2017.10.663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a severe chronic disease and its prevalence is increasing. Nevertheless, mortality linked to moderate and mild COPD without comorbidities is low. The aim of the study is to create and validate a questionnaire in primary care to spot patients with undiagnosed COPD who are at high risk of severe complications considering the severity of their COPD and their comorbidities. METHODS The development of the questionnaire has three steps. The first is the selection of the items which can be included in the questionnaire with a two-round Delphi method. The second step is a cross-sectional study to assess the link between spirometry and the selected items in the first step. The last step is the validation of the questionnaire in a prospective study in primary care. EXPECTED RESULTS Identifying undiagnosed COPD patients with a high global risk of complications in primary care will help to establish which patients have to be diagnosed as a priority. This is particularly useful in general practice as the patient is considered globally and not just on the basis of respiratory criteria. It should allow better selection of patients who need specialised follow up.
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Affiliation(s)
- A Malmartel
- Département de médecine générale, université de médecine Paris-Descartes, 75014 Paris, France.
| | - D Eap
- Département de médecine générale, université de médecine Paris-Descartes, 75014 Paris, France
| | - C Ghasarossian
- Département de médecine générale, université de médecine Paris-Descartes, 75014 Paris, France
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19
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Lisspers K, Larsson K, Johansson G, Janson C, Costa-Scharplatz M, Gruenberger JB, Uhde M, Jorgensen L, Gutzwiller FS, Ställberg B. Economic burden of COPD in a Swedish cohort: the ARCTIC study. Int J Chron Obstruct Pulmon Dis 2018; 13:275-285. [PMID: 29391785 PMCID: PMC5769573 DOI: 10.2147/copd.s149633] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting. Patients and methods Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed. Results A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013. Conclusion As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.
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Affiliation(s)
- Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
| | - Kjell Larsson
- Department of Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institute, Solna
| | - Gunnar Johansson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala
| | | | | | | | | | | | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala
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20
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Andrijevic L, Milutinov S, Andrijevic I, Jokic D, Vukoja M. Association Between the Inflammatory Biomarkers and Left Ventricular Systolic Dysfunction in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease. Balkan Med J 2017; 34:226-231. [PMID: 28443567 PMCID: PMC5450862 DOI: 10.4274/balkanmedj.2016.1114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/30/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are an important cause of morbidity and mortality in chronic obstructive pulmonary disease patients. The increased inflammatory biomarker levels predict exacerbations and are associated with cardiovascular diseases in stable chronic obstructive pulmonary disease patients but their role in the settings of acute chronic obstructive pulmonary disease exacerbations has not been determined. AIMS To analyse the association between inflammatory biomarkers and heart failure and also to determine the predictors of mortality in patients with exacerbations of chronic obstructive pulmonary disease. STUDY DESIGN Prospective observational study. METHODS We analysed 194 patients admitted for acute exacerbation of chronic obstructive pulmonary disease at The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. In all patients, C-reactive protein, fibrinogen, N-terminal of the pro-hormone brain natriuretic peptide and white blood count were measured and transthoracic echocardiography was performed. RESULTS There were 119 men (61.3%) and the median age was 69 years (interquartile range 62-74). Left ventricular systolic dysfunction (ejection fraction <50%) was present in 47 (24.2%) subjects. Patients with left ventricular systolic dysfunction had higher C-reactive protein levels (median 100 vs. 31 mg/L, p=0.001) and fibrinogen (median 5 vs. 4 g/L, p=<0.001) compared to those with preserved ejection fraction. The overall hospital mortality was 8.2% (16/178). The levels of C-reactive protein, fibrinogen, N-terminal pro-brain natriuretic peptide and ejection fraction predicted hospital mortality in univariate analysis. After adjusting for age, hypoxemia and C-reactive protein, ejection fraction remained significant predictors of hospital mortality (OR 3.89, 95% CI 1.05-15.8). CONCLUSION Nearly a quarter of patients with the exacerbation of chronic obstructive pulmonary disease present with left ventricular systolic dysfunction which may be associated with mortality.
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Affiliation(s)
- Ljiljana Andrijevic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Senka Milutinov
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Ilija Andrijevic
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | - Marija Vukoja
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
- The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
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21
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Rai KK, Jordan RE, Siebert WS, Sadhra SS, Fitzmaurice DA, Sitch AJ, Ayres JG, Adab P. Birmingham COPD Cohort: a cross-sectional analysis of the factors associated with the likelihood of being in paid employment among people with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:233-242. [PMID: 28138233 PMCID: PMC5238806 DOI: 10.2147/copd.s119467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Employment rates among those with chronic obstructive pulmonary disease (COPD) are lower than those without COPD, but little is known about the factors that affect COPD patients' ability to work. METHODS Multivariable analysis of the Birmingham COPD Cohort Study baseline data was used to assess the associations between lifestyle, clinical, and occupational characteristics and likelihood of being in paid employment among working-age COPD patients. RESULTS In total, 608 of 1,889 COPD participants were of working age, of whom 248 (40.8%) were in work. Older age (60-64 years vs 30-49 years: odds ratio [OR] =0.28; 95% confidence interval [CI] =0.12-0.65), lower educational level (no formal qualification vs degree/higher level: OR =0.43; 95% CI =0.19-0.97), poorer prognostic score (highest vs lowest quartile of modified body mass index, airflow obstruction, dyspnea, and exercise (BODE) score: OR =0.10; 95% CI =0.03-0.33), and history of high occupational exposure to vapors, gases, dusts, or fumes (VGDF; high VGDF vs no VGDF exposure: OR =0.32; 95% CI =0.12-0.85) were associated with a lower probability of being employed. Only the degree of breathlessness of BODE was significantly associated with employment. CONCLUSION This is the first study to comprehensively assess the characteristics associated with employment in a community sample of people with COPD. Future interventions should focus on managing breathlessness and reducing occupational exposures to VGDF to improve the work capability among those with COPD.
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Affiliation(s)
| | | | | | - Steven S Sadhra
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | | | | | - Jon G Ayres
- Institute of Applied Health Research
- Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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22
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Feirman SP, Glasser AM, Teplitskaya L, Holtgrave DR, Abrams DB, Niaura RS, Villanti AC. Medical costs and quality-adjusted life years associated with smoking: a systematic review. BMC Public Health 2016; 16:646. [PMID: 27460828 PMCID: PMC4962483 DOI: 10.1186/s12889-016-3319-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/16/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Estimated medical costs ("T") and QALYs ("Q") associated with smoking are frequently used in cost-utility analyses of tobacco control interventions. The goal of this study was to understand how researchers have addressed the methodological challenges involved in estimating these parameters. METHODS Data were collected as part of a systematic review of tobacco modeling studies. We searched five electronic databases on July 1, 2013 with no date restrictions and synthesized studies qualitatively. Studies were eligible for the current analysis if they were U.S.-based, provided an estimate for Q, and used a societal perspective and lifetime analytic horizon to estimate T. We identified common methods and frequently cited sources used to obtain these estimates. RESULTS Across all 18 studies included in this review, 50 % cited a 1992 source to estimate the medical costs associated with smoking and 56 % cited a 1996 study to derive the estimate for QALYs saved by quitting or preventing smoking. Approaches for estimating T varied dramatically among the studies included in this review. T was valued as a positive number, negative number and $0; five studies did not include estimates for T in their analyses. The most commonly cited source for Q based its estimate on the Health Utilities Index (HUI). Several papers also cited sources that based their estimates for Q on the Quality of Well-Being Scale and the EuroQol five dimensions questionnaire (EQ-5D). CONCLUSIONS Current estimates of the lifetime medical care costs and the QALYs associated with smoking are dated and do not reflect the latest evidence on the health effects of smoking, nor the current costs and benefits of smoking cessation and prevention. Given these limitations, we recommend that researchers conducting economic evaluations of tobacco control interventions perform extensive sensitivity analyses around these parameter estimates.
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Affiliation(s)
- Shari P. Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
| | - Allison M. Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
| | - Lyubov Teplitskaya
- Evaluation Science and Research, Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA
| | - David R. Holtgrave
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - David B. Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW E501, Washington, DC 20007 USA
| | - Raymond S. Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3970 Reservoir Road NW E501, Washington, DC 20007 USA
| | - Andrea C. Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC 20001 USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Onoue A, Omori H, Katoh T, Kubota K, Nonami Y, Ogata Y, Inoue H. Relationship of airflow limitation severity with work productivity reduction and sick leave in a Japanese working population. Int J Chron Obstruct Pulmon Dis 2016; 11:567-75. [PMID: 27042045 PMCID: PMC4801209 DOI: 10.2147/copd.s99786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to reveal the association between airflow limitation (AL) severity and reduction with work productivity as well as use of sick leave among Japanese workers. METHODS This cross-sectional study included 1,378 workers who underwent a lung function test during a health checkup at the Japanese Red Cross Kumamoto Health Care Center. AL was defined as forced expiratory volume in 1 second/forced vital capacity of <0.7. Workers completed a questionnaire on productivity loss at work and sick leave. The quality and quantity of productivity loss at work were measured on a ten-point scale indicating how much work was actually performed on the previous workday. Participants were asked how many days in the past 12 months they were unable to work because of health problems. Logistic regression analysis was used to assess the associations between AL severity and the quality and quantity of productivity loss at work as well as use of sick leave. RESULTS Compared with workers without AL, workers with moderate-to-severe AL showed a significant productivity loss (quality: odds ratio [OR] =2.04, 95% confidence interval [CI]: 1.12-3.71, P=0.02 and quantity: OR =2.19, 95% CI: 1.20-4.00, P=0.011) and use of sick leave (OR =2.69, 95% CI: 1.33-5.44, P=0.006) after adjusting for sex, age, body mass index, smoking status, hypertension, hyperglycemia, dyslipidemia, sleep duration, work hours per day, and workplace smoking environment. CONCLUSION AL severity was significantly associated with work productivity loss and use of sick leave. Our findings suggested that early intervention in the subjects with AL at the workforce might be beneficial for promoting work ability.
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Affiliation(s)
- Ayumi Onoue
- Department of Biomedical Laboratory Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Kubota
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | - Yoshio Nonami
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | - Yasuhiro Ogata
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Kim M, Ren J, Tillis W, Asche CV, Kim IK, Kirkness CS. Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:357-67. [PMID: 26955268 PMCID: PMC4769007 DOI: 10.2147/copd.s95717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED) visits and primary care physician (PCP) office visits among adults with COPD utilizing a nationally representative survey data. Methods We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011–2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers. Results Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp) (P=0.028). In contrast, an additional hospital per 100,000 persons increases the likelihood of hospital/ED visit by 0.8 pp (P=0.008). However, safety net facilities were not related to hospital utilizations. PCP office visits were not related to access-to-care factors. Conclusion Pulmonary care specialist availability was a key factor in reducing hospital utilization among adults with COPD. The findings of our study implied that an increase in the availability of pulmonary care specialists may reduce hospital utilizations in counties with little or no access to pulmonary care specialists and that since availability of hospitals increases hospital utilization, directing patients with COPD to pulmonary care specialists may decrease hospital utilizations.
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Affiliation(s)
- Minchul Kim
- Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Jinma Ren
- Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - William Tillis
- OSF St Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, USA; Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Carl V Asche
- Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA; Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Inkyu K Kim
- Battelle Memorial Institute, Atlanta, GA, USA
| | - Carmen S Kirkness
- Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA
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Lipid profile and statin use: the paradox of survival after acute exacerbation of chronic obstructive pulmonary disease. Am J Med Sci 2015; 349:338-43. [PMID: 25719977 DOI: 10.1097/maj.0000000000000435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A paradoxical association between cholesterol level and clinical outcome has been suggested, yet never previously established, in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES The authors sought to investigate the interaction between long-term survival, lipid profile and statin use in patients after acute exacerbation of COPD (AECOPD). METHODS A retrospective study evaluating demographic, clinical and laboratory data of 615 consecutive patients admitted for AECOPD over a mean follow-up period of 24.8 months. Kaplan-Meier survival curves and multivariate analysis were used to identify independent prognostic predictors for all-cause mortality. RESULTS Mean ± standard deviation (SD) age of the study population was 71.8 ± 11.4 years. Unexpectedly, mean serum cholesterol ± SD levels were significantly higher in survivors (N = 340) versus nonsurvivors (N = 275): 181.5 ± 43.6 versus 171.6 ± 57.2 mg/dL, respectively, (P = 0.0043). Median survival for patients with cholesterol levels <150 and >200 mg/dL were 16.0 and 64.4 months, respectively (P = 0.0173). On multivariate analysis, cholesterol level <150 mg/dL was an independent predictor of mortality, irrespective of cardiovascular risk factors (hazard ratio [HR] = 1.8430, 95% confidence interval [CI] = 1.2547-2.7072, P = 0.0019). Statin use had an independent protective effect, regardless of cholesterol level (HR = 0.4924, 95% CI = 0.2924-0.8292, P = 0.0080). CONCLUSIONS Low cholesterol levels are significantly associated with increased mortality after AECOPD. Nonetheless, as statin treatment was associated with reduced mortality over the entire range of cholesterol levels, its use should be considered in all COPD patients.
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Srivastava K, Thakur D, Sharma S, Punekar YS. Systematic review of humanistic and economic burden of symptomatic chronic obstructive pulmonary disease. PHARMACOECONOMICS 2015; 33:467-488. [PMID: 25663178 DOI: 10.1007/s40273-015-0252-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND An understanding of the humanistic and economic burden of individuals with symptomatic chronic obstructive pulmonary disease (COPD) is required to inform payers and healthcare professionals about the disease burden. OBJECTIVES The aim of this systematic review was to identify and present humanistic [health-related quality of life (HRQoL)] and economic burdens of symptomatic COPD. METHODS A comprehensive search of online databases (reimbursement or claims databases/other databases), abstracts from conference proceedings, published literature, clinical trials, medical records, health ministries, financial reports, registries, and other sources was conducted. Adult patients of any race or gender with symptomatic COPD were included. Humanistic and economic burdens included studies evaluating HRQoL and cost and resource use, respectively, associated with symptomatic COPD. RESULTS Thirty-two studies reporting humanistic burden and 74 economic studies were identified. Symptomatic COPD led to impairment in the health state of patients, as assessed by HRQoL instruments. It was also associated with high economic burden across all countries. The overall, direct, and indirect costs per patient increased with an increase in symptoms, dyspnoea severity, and duration of disease. Across countries, the annual societal costs associated with symptomatic COPD were higher among patients with comorbidities. CONCLUSIONS Symptomatic COPD is associated with a substantial economic burden. The HRQoL of patients with symptomatic COPD is, in general, low and influenced by dyspnoea.
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Affiliation(s)
- Kunal Srivastava
- HERON Health PVT (Now Parexel), 3rd Floor, DLF Tower E, Rajiv Gandhi IT Park, Chandigarh, India
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Lim S, Lam DCL, Muttalif AR, Yunus F, Wongtim S, Lan LTT, Shetty V, Chu R, Zheng J, Perng DW, de Guia T. Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region: the EPIC Asia population-based survey. ASIA PACIFIC FAMILY MEDICINE 2015; 14:4. [PMID: 25937817 PMCID: PMC4416253 DOI: 10.1186/s12930-015-0020-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/18/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a clinical syndrome encompassing a group of chronic, progressive, and debilitating respiratory conditions, that are characterized by incompletely reversible airflow limitation. Within the Asia-Pacific region, prevalence estimates have been derived using various protocols and study methods, and there is little data on the impact of COPD exacerbations. This study aimed to provide a comprehensive picture of the current prevalence and burden of COPD in this region. METHODS A population-based survey was conducted in nine Asia-Pacific territories between 01 February 2012 and 16 May 2012. Overall, 112,330 households were screened to identify eligible subjects (aged ≥40 years, with a physician diagnosis of COPD, chronic bronchitis or emphysema, or with identifiable symptoms of chronic bronchitis). Out of a sample of 69,279 individuals aged ≥40 years, 4,289 subjects with COPD were identified. Data were collected via face-to-face interviews or by fixed-line telephone, using a structured questionnaire. A total of 1,841 completed questionnaires were analyzed. RESULTS The overall estimated COPD prevalence was 6.2%, with 19.1% of subjects having severe COPD. In the 12 months prior to the survey, nearly half of all subjects (46%) had experienced exacerbations, and 19% had been hospitalized as a result of their condition. When subjects were asked about the impact of their condition on employment, 23% said their condition kept them from working, and 42% felt that their condition limited their ability to work or their activities. Of those who reported taking prescription drugs, 20% did not know the name of the drugs they were taking. Prescription of oral corticosteroids was common, with 44% of subjects having used these during the previous year to manage their respiratory symptoms; in contrast, inhaler use was low (25%). Only 37% of subjects had taken a lung function test, and the majority (89%) of those tested did not know their test results. CONCLUSIONS Across the Asia-Pacific territories surveyed, the prevalence of COPD is high, indicating a substantial socioeconomic burden. Our findings suggest that there is considerable room for improvement in the management of COPD, and highlight a need to enhance patient and physician education in the region.
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Affiliation(s)
- Sam Lim
- />Duke-NUS Graduate School of Medicine, Singapore, Singapore
| | | | | | - Faisal Yunus
- />Department of Pulmonology and Respiratory Medicine, Universitas Indonesia (FMUI), Jakarta, Indonesia
| | - Somkiat Wongtim
- />Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Le Thi Tuyet Lan
- />Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Vikram Shetty
- />Takeda Pharmaceuticals (Asia-Pacific) Pte. Ltd, Singapore, Singapore
| | - Romeo Chu
- />Takeda Pharmaceuticals (Asia-Pacific) Pte. Ltd, Singapore, Singapore
| | - Jinping Zheng
- />State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Diahn-Warng Perng
- />Chest Department, Taipei Veterans General Hospital and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Teresita de Guia
- />Division of Pulmonary and Critical Care Medicine, Philippine Heart Center, Quezon City, Philippines
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Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, Colpani V, Mendis S, Chowdhury R, Bramer WM, Pazoki R, Franco OH. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30:357-95. [PMID: 25837965 PMCID: PMC4457808 DOI: 10.1007/s10654-015-0026-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022]
Abstract
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
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Affiliation(s)
- Layal Chaker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Impact of a Telehealth and Care Management Program for Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2015; 12:323-31. [DOI: 10.1513/annalsats.201501-042oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Hijjawi SB, Abu Minshar M, Sharma G. Chronic obstructive pulmonary disease exacerbation: A single-center perspective on hospital readmissions. Postgrad Med 2015; 127:343-8. [PMID: 25687324 DOI: 10.1080/00325481.2015.1015394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third most common cause in the United States of hospital readmission within 30 days of discharge. Readmissions, which are attributed to poor quality of care, are costly. We examined the factors associated with 30-day readmission in patients hospitalized with acute exacerbation of COPD. Our hypothesis was that early readmissions among patients with COPD are related to patient factors rather than system or provider factors. METHODS We performed a retrospective chart review of all patients discharged from our facility from June 2010 to May 2011 with a primary discharge diagnosis of COPD. Detailed patient characteristics were obtained from the electronic medical record. Patients were followed for 30 days post-discharge date. We examined the differences in baseline characteristics of patients readmitted within 30 days and those not readmitted. RESULTS A total of 160 patients were admitted for 192 hospitalizations during the study period; 31 patients (19.4%) were readmitted within 30 days. Patients who were readmitted did not differ from those who were not readmitted of the following factors: baseline medication use, length of stay, and outpatient follow-up postdischarge. Readmitted patients were more likely to be black, to have coronary artery disease, to have a history of alcohol abuse, and to be on supplemental oxygen. Multivariate analysis showed a 2.17 odds of 30-day readmission (95% CI, 1.16-4.09) in patients with alcohol abuse, and 2.52 (95% CI, 1.18-5.38) in those on supplemental oxygen. CONCLUSION In our study population, 19.4% of acute exacerbation COPD patients were readmitted within 30 days. Patient factors (such as alcohol abuse and advanced disease) were associated with 30-day readmission.
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Affiliation(s)
- Shadi B Hijjawi
- Department of Internal Medicine, University of Texas Medical Branch , Galveston, TX
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31
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d-dimer as a Prognostic Biomarker for Mortality in Chronic Obstructive Pulmonary Disease Exacerbation. Am J Med Sci 2015; 349:29-35. [DOI: 10.1097/maj.0000000000000332] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chang C, Zhu H, Shen N, Han X, Chen Y, He B. Utility of the combination of serum highly-sensitive C-reactive protein level at discharge and a risk index in predicting readmission for acute exacerbation of COPD. J Bras Pneumol 2014; 40:495-503. [PMID: 25410837 PMCID: PMC4263330 DOI: 10.1590/s1806-37132014000500005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/22/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Frequent readmissions for acute exacerbations of COPD (AECOPD) are an independent risk factor for increased mortality and use of health-care resources. Disease severity and C-reactive protein (CRP) level are validated predictors of long-term prognosis in such patients. This study investigated the utility of combining serum CRP level with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) exacerbation risk classification for predicting readmission for AECOPD. METHODS This was a prospective observational study of consecutive patients hospitalized for AECOPD at Peking University Third Hospital, in Beijing, China. We assessed patient age; gender; smoking status and history (pack-years); lung function; AECOPD frequency during the last year; quality of life; GOLD risk category (A-D; D indicating the greatest risk); and serum level of high-sensitivity CRP at discharge (hsCRP-D). RESULTS The final sample comprised 135 patients. Of those, 71 (52.6%) were readmitted at least once during the 12-month follow-up period. The median (interquartile) time to readmission was 78 days (42-178 days). Multivariate analysis revealed that serum hsCRP-D ≥ 3 mg/L and GOLD category D were independent predictors of readmission (hazard ratio = 3.486; 95% CI: 1.968-6.175; p < 0.001 and hazard ratio = 2.201; 95% CI: 1.342-3.610; p = 0.002, respectively). The ordering of the factor combinations by cumulative readmission risk, from highest to lowest, was as follows: hsCRP-D ≥ 3 mg/L and GOLD category D; hsCRP-D ≥ 3 mg/L and GOLD categories A-C; hsCRP-D < 3 mg/L and GOLD category D; hsCRP-D < 3 mg/L and GOLD categories A-C. CONCLUSIONS Serum hsCRP-D and GOLD classification are independent predictors of readmission for AECOPD, and their predictive value increases when they are used in combination.
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Affiliation(s)
- Chun Chang
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Hong Zhu
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Xiang Han
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yahong Chen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
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Farias CC, Resqueti V, Dias FAL, Borghi-Silva A, Arena R, Fregonezi GAF. Costs and benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease: a randomized controlled trial. Braz J Phys Ther 2014; 18:165-73. [PMID: 24838809 PMCID: PMC4183253 DOI: 10.1590/s1413-35552012005000151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 10/02/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The current study evaluated the costs and benefits of a simple aerobic walking program for patients with chronic obstructive pulmonary disease (COPD). METHOD This was a blinded randomized controlled clinical trial that recruited 72 patients diagnosed with COPD, 40 of whom were included in the study and divided into two groups [control group (CG) and pulmonary rehabilitation group (GPR)]. We assessed pulmonary function, distance covered during the 6-minute walk test (6MWT), respiratory and peripheral muscle strength, health-related quality of life (HRQOL), body composition, and level of activities of daily living (ADLs) before and after an 8-week walking program. The financial costs were calculated according to the pricing table of the Brazilian Unified Health System (SUS). RESULTS Only 34 of the 40 patients remained in the final sample; 16 in the CG and 18 in the GPR (FEV1: 50.9 ± 14% predicted and FEV1: 56 ± 0.5% predicted, respectively). The intervention group exhibited improvements in the 6MWT, sensation of dyspnea and fatigue, work performed, BODE index (p<0.01), HRQOL, ADL level (p<0.001), and lower limb strength (p<0.05). The final mean cost per patient for the GPR was R$ 148.75 (~US$ 75.00) and no patient significantly exceeded this value. However, 2 patients in the CG did exceed this value, incurring a cost of R$ 689.15 (~US$ 345.00). CONCLUSION Aerobic walking demonstrated significant clinical benefits in a cost-efficient manner in patients with COPD.
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Affiliation(s)
- Catharinne C Farias
- Physical Therapy Department, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Vanessa Resqueti
- Physical Therapy Department, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Fernando A L Dias
- Physical Therapy Department, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Audrey Borghi-Silva
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Ross Arena
- Physical Therapy Department, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Patel JG, Nagar SP, Dalal AA. Indirect costs in chronic obstructive pulmonary disease: a review of the economic burden on employers and individuals in the United States. Int J Chron Obstruct Pulmon Dis 2014; 9:289-300. [PMID: 24672234 PMCID: PMC3964024 DOI: 10.2147/copd.s57157] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD.
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Affiliation(s)
- Jeetvan G Patel
- Pharmacy Administration and Public Health, University of Houston, Houston, TX, USA ; US Health Outcomes, GlaxoSmithKline, Durham, NC, USA
| | | | - Anand A Dalal
- US Health Outcomes, GlaxoSmithKline, Durham, NC, USA
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Breunig IM, Shaya FT, Scharf SM. Delivering cost–effective care for COPD in the USA: recent progress and current challenges. Expert Rev Pharmacoecon Outcomes Res 2014; 12:725-31. [DOI: 10.1586/erp.12.69] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Antwi S, Steck SE, Heidari K. Association between prevalence of chronic obstructive pulmonary disease and health-related quality of life, South Carolina, 2011. Prev Chronic Dis 2013; 10:E215. [PMID: 24370110 PMCID: PMC3873217 DOI: 10.5888/pcd10.130192] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction We investigated the prevalence of chronic obstructive pulmonary disease (COPD) in various population subgroups in South Carolina and examined associations between COPD and 4 core measures of health-related quality of life (HRQOL). Methods Data from 12,851 participants of the 2011 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. COPD prevalence rates were age-adjusted to the 2000 standard US population. Logistic regression models were used to estimate adjusted odds ratios (AOR’s) and 95% confidence intervals (CIs). Results The overall age-adjusted prevalence of self-reported diagnosis of COPD among community-dwelling adults in South Carolina in 2011 was 7.1% (standard error [SE] ±0.3). Prevalence of self-reported diagnosis of COPD was highest among women (8.9%; SE, ±0.5), those aged 65 years or older (12.9%; SE, ±0.5), current smokers (15.9%; SE, ±0.7), and those with low levels of education and income. Compared with community-dwelling adults without COPD, those with COPD were more likely to report fair or poor general health status (AOR, 3.97; 95% CI, 3.13–5.03), 14 or more physically unhealthy days (AOR, 2.10, 95% CI, 1.57–2.81), 14 or more mentally unhealthy days (AOR, 1.72; 95% CI, 1.21–2.43), and 14 or more days of activity limitation (AOR, 2.22; 95% CI, 1.53–3.22) within the previous 30 days. Conclusion COPD is a highly prevalent disease in South Carolina, especially among older people and smokers, and it is associated with poor HRQOL. Future work aimed at reducing risk factors may decrease the disease prevalence, and increasing early detection and improving access to appropriate medical treatments can improve HRQOL for those living with COPD.
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Affiliation(s)
- Samuel Antwi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina. 800 Sumter Street, Columbia SC, 29208. E-Mail:
| | - Susan E Steck
- Arnold School of Public Health, University of South Carolina, Columbia South Carolina
| | - Khosrow Heidari
- Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health & Environmental Control, Columbia, South Carolina
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Risør MB, Spigt M, Iversen R, Godycki-Cwirko M, Francis N, Altiner A, Andreeva E, Kung K, Melbye H. The complexity of managing COPD exacerbations: a grounded theory study of European general practice. BMJ Open 2013; 3:e003861. [PMID: 24319274 PMCID: PMC3856618 DOI: 10.1136/bmjopen-2013-003861] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). DESIGN 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs. SETTING Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong). PARTICIPANTS 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians. RESULTS Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from 'dealing with comorbidity' through 'having difficult patients' to 'confronting a hopeless disease'. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label 'difficult' exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with 'a hopeless disease' due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition. CONCLUSIONS Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning.
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Affiliation(s)
- Mette Bech Risør
- Department of Community Medicine, General Practice Research Unit, UiT The Arctic University of Norway, Tromsø, Norway
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Ghattas C, Dai A, Gemmel DJ, Awad MH. Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population. Int J Chron Obstruct Pulmon Dis 2013; 8:545-9. [PMID: 24348030 PMCID: PMC3848507 DOI: 10.2147/copd.s45693] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction While cross-national studies have documented rates of chronic obstructive pulmonary disease
(COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating
diagnosis among uninsured patients are lacking. Objective The purpose of this study is to identify patients who are over diagnosed and thus, mistreated,
for COPD in a federally qualified health center. Methods A descriptive study was conducted for a retrospective cohort from February 2011 to June 2012.
Spirometry was performed by trained personnel following American Thoracic Society recommendations.
Patients were referred for spirometry to confirm previous COPD diagnosis or to assess uncontrolled
COPD symptoms. Airway obstruction was defined as a forced expiratory volume in the first second of
expiration (FEV1) to forced vital capacity ratio less than 0.7. Reversibility was defined
as a postbronchodilator increase in FEV1 greater than 200 mL and greater than 12%. Results Eighty patients treated for a previous diagnosis of COPD (n = 72) or on anticholinergic inhalers
(n = 8) with no COPD diagnosis were evaluated. The average age was 52.9 years; 71% were uninsured.
Only 17.5% (14/80) of patients reported previous spirometry. Spirometry revealed that 42.5% had no
obstruction, 22.5% had reversible obstruction, and 35% had non-reversible obstruction. Conclusion Symptoms and smoking history are insufficient to diagnose COPD. Prevalence of COPD over diagnosis
among uninsured patient populations may be higher than previously reported. Confirming previous COPD
diagnosis with spirometry is essential to avoid unnecessary and potentially harmful treatment.
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Affiliation(s)
- Christian Ghattas
- Department of Internal Medicine, St Elizabeth Health Center, Youngstown, OH, USA
| | - Allen Dai
- Northeast Ohio Medical University College of Pharmacy, Rootstown, OH, USA
| | - David J Gemmel
- Department of Medical Education and Research, St Elizabeth Health Center, Youngstown, OH, USA
| | - Magdi H Awad
- Northeast Ohio Medical University College of Pharmacy, Rootstown, OH, USA
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Thomas M, Radwan A, Stonham C, Marshall S. COPD exacerbation frequency, pharmacotherapy and resource use: an observational study in UK primary care. COPD 2013; 11:300-9. [PMID: 24152210 DOI: 10.3109/15412555.2013.841671] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) management represents a significant health resource use burden. Understanding of current resource use, treatment strategies and outcomes can improve future COPD management, for patient benefit and to aid efficient service delivery. This study aimed to describe exacerbation frequency, pharmacotherapy and health resource use in COPD management in routine UK primary care. A retrospective, observational study using routine clinical records of 511 patients with COPD, was undertaken in 10 General Practices in England. Up to 3 years' patient data were collected and analysed. 75% (234/314) patients with mild-moderate COPD (≥50% predicted FEV1) received inhaled corticosteroids (ICS). 11% of patients (54/511) received ICS monotherapy. Mean (standard deviation) annual exacerbation frequency was 1.1 (1.2) in mild-moderate, 1.7 (1.6) in severe (30-49% predicted FEV1) and 2.2 (2.0) in very severe (<30% predicted FEV1) COPD. 14% patients (69/511) had a mean exacerbation frequency of ≥3/year ('frequent-exacerbators'); 9% (27/314) of patients with mild-moderate, 19% (27/145) with severe and 29% (15/52) with very severe COPD. 14% (10/69) of frequent-exacerbators failed to receive inhaled long-acting beta agonists (LABA), 25% (17/69) inhaled long-acting muscarinic antagonists (LAMA), and 12% (`/69) ICS. Frequent-exacerbators had a median of 6.67 primary care contacts/year, 1.0 secondary care visits/year and 21% were hospitalised for COPD/year. Inhaled therapy was frequently inappropriate, with over-use of ICS in patients with mild-moderate COPD. COPD exacerbations were associated with high health resource use and occurred at all levels of disease severity. COPD management strategies should encompass risk-stratification for both exacerbation frequency and physiological impairment.
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Affiliation(s)
- Mike Thomas
- 1Department of Primary Care Research, University of Southampton , UK
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Jansson SA, Backman H, Stenling A, Lindberg A, Rönmark E, Lundbäck B. Health economic costs of COPD in Sweden by disease severity--has it changed during a ten years period? Respir Med 2013; 107:1931-8. [PMID: 23910072 DOI: 10.1016/j.rmed.2013.07.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 06/24/2013] [Accepted: 07/11/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of the presented study were to estimate societal costs of COPD in Sweden, the relationship between costs and disease severity, and possible changes in the costs during the last decade. METHODS Subjects with COPD derived from the general population in Northern Sweden were interviewed by telephone regarding their resource utilisation and productivity losses four times quarterly during 2009-10. Mean annual costs were estimated for each severity stage of COPD. RESULTS A strong relationship was found between disease severity and costs. Estimated mean annual costs per subject of mild, moderate, severe and very severe COPD amounted to 596 (SEK 5686), 3245 (SEK 30,957), 5686 (SEK 54,242), and 17,355 euros (SEK 165,569), respectively. The main cost drivers for direct costs were hospitalisations (for very severe COPD) and drugs (all other severity stages). The main cost driver for indirect costs was productivity loss due to sick-leave (for mild COPD) and early retirement (all other severity stages). Costs appeared to be lower in 2010 than in 1999 for subjects with severe and very severe COPD, but higher for those with mild and moderate COPD. CONCLUSION Our results show that costs of COPD are strongly related to disease severity, and scaling the data to the whole Swedish population indicates that the total costs in Sweden amounted to 1.5 billion euros (SEK 13.9 bn) in 2010. In addition, costs have decreased since 1999 for subjects with severe and very severe COPD, but increased for those with mild and moderate COPD.
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Affiliation(s)
- Sven-Arne Jansson
- The OLIN Studies, Norrbotten County Council, Robertsviksgatan 9, SE-971 89 Luleå, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, SE-901 87 Umeå, Sweden.
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Gerke AK, Tang F, Yang M, Foster ED, Cavanaugh JE, Polgreen PM. Predicting chronic obstructive pulmonary disease hospitalizations based on concurrent influenza activity. COPD 2013; 10:573-80. [PMID: 23819753 DOI: 10.3109/15412555.2013.777400] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although influenza has been associated with chronic obstructive pulmonary disease (COPD) exacerbations, it is not clear the extent to which this association affects healthcare use in the United States. The first goal of this project was to determine to what extent the incidence of COPD hospitalizations is associated with seasonal influenza. Second, as a natural experiment, we used influenza activity to help predict COPD admissions during the 2009 H1N1 influenza pandemic. To do this, we identified all hospitalizations between 1998 and 2010 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP) during which a primary diagnosis of COPD was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We formulated time series regression models to investigate the association of monthly COPD admissions with influenza incidence. Finally, we applied these models, fit using 1998-2008 data, to forecast monthly COPD admissions during the 2009 pandemic. Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of COPD hospitalizations (p-value < 0.0001). The association is especially strong among older patients requiring mechanical ventilation. Use of influenza data to predict COPD admissions during the 2009 H1N1 pandemic reduced the mean-squared prediction error by 29.9%. We conclude that influenza activity is significantly associated with COPD hospitalizations in the United States and influenza activity can be exploited to more accurately forecast COPD admissions. Our results suggest that improvements in influenza surveillance, prevention, and treatment may decrease hospitalizations of patients diagnosed with COPD.
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Affiliation(s)
- Alicia K Gerke
- 1Department of Internal Medicine, University of Iowa , Iowa City, IA , USA
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Uzaslan E, Mahboub B, Beji M, Nejjari C, Tageldin MA, Khan JA, Nafti S, Obeidat NM, Sayiner A, Wali S, Rashid N, El Hasnaoui A. The burden of chronic obstructive pulmonary disease in the Middle East and North Africa: results of the BREATHE study. Respir Med 2013; 106 Suppl 2:S45-59. [PMID: 23290704 DOI: 10.1016/s0954-6111(12)70014-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
COPD is a progressive pulmonary disease which may have a profound impact on general health status and quality of life. This article presents data on the burden of COPD obtained from the BREATHE study in the Middle East, North Africa and Pakistan. This study was a large general population survey of COPD conducted in eleven countries of the region using a standardised methodology. A total of 62,086 subjects were screened, of whom 2,187 fulfilled the "epidemiological" definition of COPD. Data on symptoms, perceived disease severity, impact on work, limitations in activities and psychological distress were collected. 1,392 subjects were analysable of whom 661 (47.5%) reported experiencing an exacerbation of their respiratory condition, 49.4% reported comorbidities and 5.5% reported severe breathlessness as measured with the MRC breathlessness questionnaire. The degree of breathlessness, as well as the perceived severity, was correlated with the overall disease impact as measured with the COPD Assessment Test (p < 0.001). 374 subjects (28.4%) reported that their respiratory condition prevented them from working and this proportion rose to 47.8% in subjects who perceived their respiratory condition as severe. 47.9% of subjects reported difficulties in normal physical exertion, 37.5% in social activities and 31.7% in family activities. Psychological distress was reported by between 42.3% and 53.2% of subjects, depending on the item. In conclusion, the burden of COPD is important, and covers central aspects of daily life. For this reason, physicians should take time to discuss it with their patients, and ensure that the management strategy proposed addresses all their needs.
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Affiliation(s)
- Esra Uzaslan
- Uludag University Medical Faculty, Bursa, Turkey
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Mapel DW, Roberts MH. New clinical insights into chronic obstructive pulmonary disease and their implications for pharmacoeconomic analyses. PHARMACOECONOMICS 2012; 30:869-85. [PMID: 22852587 PMCID: PMC3625413 DOI: 10.2165/11633330-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death and disability worldwide, but before the development of several new pharmacological treatments little could be done for COPD patients. Recognition that these new treatments could significantly improve the prognosis for COPD patients has radically changed clinical management guidelines from a palliative philosophy to an aggressive approach intended to reduce chronic symptoms, improve quality of life and prolong survival. These new treatments have also sparked interest in COPD cost-effectiveness research. Most COPD cost-effectiveness studies have been based on clinical trial populations, limited to direct medical costs, and used standard analysis methods such as Markov modelling, and they have usually found that newer therapies have favourable cost effectiveness. However, new insights into the clinical progression of COPD bring into question some of the assumptions underlying older analyses. In this review, we examine clinical factors unique to COPD and recent changes in clinical perspectives that have important implications for pharmacoeconomic analyses. The main parameters explored include (i) the high indirect medical costs for COPD and their relevance in assessing the societal benefits of new therapy; (ii) the importance of acute deteriorations in COPD, known as exacerbations, and approaches to modelling the cost benefit of exacerbation reduction; (iii) quality/utility instruments for COPD; (iv) the prevalence of co-morbid conditions and confounding between COPD and co-morbid disease utilization; (v) the limitations of Markov modelling; and (vi) the problem of outliers.
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Affiliation(s)
- Douglas W Mapel
- Lovelace Clinic Foundation, Albuquerque, MN 87106-4264, USA.
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Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD 2012; 9:131-41. [PMID: 22409371 DOI: 10.3109/15412555.2011.650239] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a leading cause of hospitalizations in the United States and the major cost driver of COPD. This study determined the national inpatient burden of AECOPD and assessed the association of co-morbidities and hospital characteristics with inpatient costs and mortality. Discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample for 2006 was utilized. Outcomes of costs and mortality were assessed for AECOPD hospitalizations in cases ≥40 years of age. Multivariate regression analyses using a generalized linear model framework were conducted to determine predictors of inpatient costs and mortality controlling for patient demographics, primary payer, co-morbidity index, length of stay, hospital region, mechanical ventilation, and admission period. Overall, 1,254,703 hospitalizations for AECOPD were observed with mean costs of $9545(±12,700) and total costs of $11.9 billion. In-hospital mortality was 4.3% (N = 53,748). Discharges averaged 70.6 (±11.9) years of age. The majority were female (52.8%) and of white race (83.6% of reported race). Several co-morbidities were significantly associated with both costs and mortality (p < 0.001): acute myocardial infarction; congestive heart failure; cerebrovascular disease; lung cancer; cardiac arrhythmias; pulmonary circulation disorders; and weight loss. Significantly higher costs (p < 0.001) were associated with large and urban hospitals. The importance of co-morbidities in AECOPD is indicated in their association with prognosis and inpatient costs. Future research should determine if better management of these conditions can favorably impact the COPD disease burden.
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Affiliation(s)
- Prasadini N Perera
- The University of Arizona, College of Pharmacy, Center for Health Outcomes and PharmcoEconomic Research, Tucson, Arizona 85721, USA.
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Nair K, Ghushchyan V, Van Den Bos J, Halford ML, Tan G, Frech-Tamas FH, Doyle J. Burden of illness for an employed population with chronic obstructive pulmonary disease. Popul Health Manag 2012; 15:267-75. [PMID: 22401150 DOI: 10.1089/pop.2011.0049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects approximately 7% of Americans. COPD impacts productivity and forces 1 in 5 employees ages 45-65 years old to retire prematurely. Our objective was to quantify the direct and indirect costs of COPD in an employed population in the United States. A retrospective analysis using Thomson Reuters MarketScan commercial claims and Health and Productivity (HPM) databases (2000-2007) identified employees (ages 18-65 years) with ≥ 1 COPD medical claim, ≥ 6 month insurance eligibility pre and ≥ 12 months post diagnosis, and ≥ 12 months HPM data post diagnosis. COPD subjects were matched to non-COPD subjects using propensity scores to create a comparison group with similar characteristics. Differences in medical and pharmacy utilization and productivity (absence and short-term disability [STD] days) were examined using negative binomial regression, and cost differences using Heckman selection models. A total of 27,612 COPD patients were matched in a 1:1 ratio to 825,884 non-COPD patients; 80% were ages 36-65 years, and 59% were male. COPD employees had about twice the rate of emergency department visits and hospitalizations compared to non-COPD employees (P<0.0001). The rate of absence and STD days was approximately 1.5 times higher (P<0.0001) compared to non-COPD employees. Yearly direct and indirect expenditures were higher ($3609 and $909, respectively; P<0.0001) for COPD versus non-COPD employees. Excess utilization and associated costs of COPD to employers was quantified. By understanding these costs, employers may evaluate disease management programs and treatment to improve outcomes for employees with COPD. Improved treatment options may reduce the direct and indirect costs of COPD.
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Affiliation(s)
- Kavita Nair
- School of Pharmacy, University of Colorado Denver, Denver, CO 80045, USA.
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Dormuth CR, Yamaguchi J, Wilmer B, Hosick D, Stürmer T, Carney G. Comparative health-care cost advantage of ipratropium over tiotropium in COPD patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:269-276. [PMID: 22433758 DOI: 10.1016/j.jval.2011.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/19/2011] [Accepted: 10/21/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare the total direct health-care costs of patients treated with tiotropium and ipratropium. METHODS We conducted a cohort study of health-care costs in British Columbia, Canada, by comparing new patients on tiotropium with new patients on ipratropium. Direct health-care costs for study patients were measured in the first 2 years after initiating inhaled anticholinergic treatment. Differences in direct health-care costs between tiotropium and ipratropium patients were estimated by using quantile regression. We analyzed cost differences in the 10th percentile, median, and 90th percentile of patients by cost. High-dimensional propensity score analysis was used as a method of adjustment for potential confounding factors. RESULTS The study population had 3,140 tiotropium patients and 26,182 ipratropium patients. Higher health system costs in patients who started on tiotropium instead of ipratropium were observed in patients in the median and 10th percentile. The magnitude of these increases was comparable to the price difference between the two drugs. Health system costs in the 90th percentile were not significantly different between tiotropium and ipratropium patients. CONCLUSIONS The results of this study did not support the preferential use of tiotropium over ipratropium as a basis for savings in direct health-care costs.
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Affiliation(s)
- Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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Goodwin RD, Lavoie KL, Lemeshow AR, Jenkins E, Brown ES, Fedoronko DA. Depression, anxiety, and COPD: the unexamined role of nicotine dependence. Nicotine Tob Res 2012; 14:176-83. [PMID: 22025539 PMCID: PMC3265744 DOI: 10.1093/ntr/ntr165] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 07/01/2011] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Previous studies have shown links between anxiety and depression and chronic obstructive pulmonary disease (COPD), but little is known about possible mechanisms of this association. The current study examined whether the observed relationship between anxiety and depression and COPD is explained by confounding due to cigarette smoking and lifetime nicotine dependence. METHODS Data were drawn from the National Comorbidity Survey Replication, a community-based representative sample of adults in the United States. RESULTS Analyses suggest that the association between anxiety disorders and COPD appears to be largely explained by confounding by former cigarette smoking and lifetime nicotine dependence. The association between mood disorders and COPD appears to be largely explained by confounding by lifetime nicotine dependence. CONCLUSIONS These findings provide initial evidence suggesting that the association between anxiety, depression, and COPD may be at least partly attributable to confounding by cigarette smoking and nicotine dependence. Efforts toward prevention of chronic lung disease may be more effective if treatment and prevention efforts aimed at smoking cessation address mental health problems.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 1505, New York, NY 10032, USA.
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Fromer L. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. Int J Chron Obstruct Pulmon Dis 2011; 6:605-14. [PMID: 22162647 PMCID: PMC3232168 DOI: 10.2147/copd.s24692] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Current primary care patterns for chronic obstructive pulmonary disease (COPD) focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.
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Affiliation(s)
- Len Fromer
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Dalal AA, Liu F, Riedel AA. Cost trends among commercially insured and Medicare Advantage-insured patients with chronic obstructive pulmonary disease: 2006 through 2009. Int J Chron Obstruct Pulmon Dis 2011; 6:533-42. [PMID: 22069365 PMCID: PMC3206770 DOI: 10.2147/copd.s24591] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Few estimates of health care costs related to chronic obstructive pulmonary disease (COPD) are available regarding commercially insured patients in the United States. The aims of this retrospective observational analysis of administrative data were to describe and compare health care resource use and costs related to COPD in the United States for patients with commercial insurance or Medicare Advantage with Part D benefits, and to assess cost trends over time. METHODS Patient-level and visit-level health care costs in the calendar years 2006, 2007, 2008, and 2009 were assessed for patients with evidence of COPD. Generalized linear models adjusting for sex, age category, and geographic region were used to investigate cost trends over time for patients with Medicare or commercial insurance. RESULTS Medical costs, which ranged from an annual mean of US$2382 (Medicare 2007) to US$3339 (commercial 2009) per patient, comprised the majority of total costs in all years for patients with either type of insurance. COPD-related costs were less for Medicare than commercial cohorts. In the multivariate analysis, total costs increased by approximately 6% per year for commercial insurance patients (cost ratio 1.06; 95% confidence interval [CI] 1.04-1.07; P < 0.001) and 5% per year for Medicare patients (cost ratio 1.05; 95% CI 1.03-1.07; P < 0.001). Costs for outpatient and emergency department visits increased significantly over time in both populations. Standard admission costs increased significantly for Medicare patients (cost ratio 1.03; 95% CI 1.00-1.05; P = 0.03), but not commercial patients, and costs for intensive care unit visits remained stable for both populations. CONCLUSION COPD imposed a substantial economic burden on patients and the health care system, with costs increasing significantly in both the Medicare and commercial populations.
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Affiliation(s)
- Anand A Dalal
- US Health Outcomes, GlaxoSmithKline, Research Triangle Park, Durham, NC 27709, USA.
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Fletcher MJ, Upton J, Taylor-Fishwick J, Buist SA, Jenkins C, Hutton J, Barnes N, Van Der Molen T, Walsh JW, Jones P, Walker S. COPD uncovered: an international survey on the impact of chronic obstructive pulmonary disease [COPD] on a working age population. BMC Public Health 2011; 11:612. [PMID: 21806798 PMCID: PMC3163200 DOI: 10.1186/1471-2458-11-612] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 210 million people are estimated to have chronic obstructive pulmonary disease [COPD] worldwide. The burden of disease is known to be high, though less is known about those of a younger age. The aim of this study was to investigate the wider personal, economic and societal burden of COPD on a cross country working-age cohort. METHODS A cross-country [Brazil, China, Germany, Turkey, US, UK] cross-sectional survey methodology was utilised to answer the research questions. 2426 participants aged 45-67 recruited via a number of recruitment methods specific to each country completed the full survey. Inclusion criteria were a recalled physician diagnosis of COPD, a smoking history of > 10 pack years and the use of COPD medications in the previous 3 months prior to questioning. The survey included items from the validated Work Productivity and Activity Impairment [WPAI] scale and the EuroQoL 5 Dimension [EQ-5D] scale. Disease severity was measured using the 5-point MRC [Medical Research Council] dyspnoea scale as a surrogate measure. RESULTS 64% had either moderate [n = 1012] or severe [n = 521] COPD, although this varied by country. 75% of the cohort reported at least one comorbid condition. Quality of life declined with severity of illness [mild, mean EQ-5D score = 0.84; moderate 0.58; severe 0.41]. The annual cost of healthcare utilisation [excluding treatment costs and diagnostic tests] per individual was estimated to be $2,364 [£1,500]. For those remaining in active employment [n: 677]: lost time from work cost the individual an average of $880 [£556] per annum and lifetime losses of $7,365 [£4,661] amounting to $596,000 [£377,000] for the cohort. 447 [~40%] of the working population had retired prematurely because of COPD incurring individual estimated lifetime income losses of $316,000 [£200,000] or a combined total of $141 m [£89.6 m]. As the mean age of retirees was 58.3 and average time since retirement was 4 years, this suggests the average age of retirement is around 54. This would mean a high societal and economic impact in all study countries, particularly where typical state retirement ages are higher, for example in Brazil, Germany and the UK [65] and the US [65,66,67], compared to Turkey [58 for women, 60 for men] and China [60]. CONCLUSIONS Although generalisation across a broader COPD population is limited due to the varied participant recruitment methods, these data nevertheless suggest that COPD has significant personal, economic and societal burden on working age people. Further efforts to improve COPD diagnosis and management are required.
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