| Have C hronic O bstructive P ulmonary D isease admissions increased over the last decade?

| Have Chronic Obstructive Pulmonary Disease admissions increased over the last decade? Class 10 | Introdução à

Medicina | 2011/2012

Associated Pathologies

COPD |

Organizational Chart 1 – Co-occurrence of emphysema, asthma and chronic bronchitis in COPD

Picture 1

2

Triggering FactorsCOPD |

11 Smoke

Air Pollution

33 Genetics

2Picture 2

[1] Foreman, M. G., L. Zhang, et al. (2011). 3

COPD |Symptoms

Limitation of the flow of air to and from the lungs

Hyperinflation

Dyspnea

Hemoptysis

Sputum

✓ 11

22

33

44

55

Picture 3

4

COPD |Symptoms


Hyperinflation

Dyspnea

Hemoptysis

Sputum

✓

11

22

33

44

55

Picture 4

5

COPD |Symptoms


Hyperinflation

Dyspnea

Hemoptysis

Sputum

✓

11

22

33

44

55

Picture 5

6

COPD |Symptoms


Hyperinflation

Dyspnea

Hemoptysis

Sputum✓

11

22

33

44

55

7

COPD |Symptoms


Hyperinflation

Dyspnea

Hemoptysis

Sputum

✓

11

22

33

44

55

8

Favorable Prognosis

Treatment

Early Diagnosis.

Ideal steps in clinical practice

Picture 8

COPD|

9

Treatments

Quit smoking

Pharmaceutical treatment

Oxygen therapy

Surgery

11

22

33

44

Picture 6

COPD|

10

COPD |Symptomatic Cases

Table 1 – COPD place among main death causes in developed countries

[2] Rodgers, A., M. Ezzati, et al. (2004).

11

Table 1 – COPD place among main death causes in developed countries

COPD |Symptomatic Cases

12

210 million people have COPD and 3 million people

died from COPD in 2005 corresponding to 5% of all

deaths globally. Meanwhile, COPD is predicted to be

the third leading cause of death worldwide by 2030.

[2] Rodgers, A., M. Ezzati, et al. (2004).

[3]World Health Organization (2011) Burden of Chronic respiratory disease. 2011.

“

”

COPD |Prevalence in Portugal

Table 1 – COPD prevalence in Portugal and its distribution according to age group and sex

13[13] Araújo AT. Epidemiologia da DPOC em Portugal e no mundo.

ArticlesCOPD|

Report from the portuguese national observatory of respiratory diseases

[4]Report from the portuguese national observatory of respiratory diseases 2009

14

Although COPD prevalence in the Portuguese Total number of admissions is not as significant as is in other countries, it is the second main cause of admissions to hospitals in cases of respiratory diseases;

Tobacco is the main cause of COPD (85% of cases).

The burden of disease attributable to smoking in Portugal

[9] Borges, M., M. Gouveia, et al. (2009).

The proportion of smokers in Portugal is of 20,2% in the general Total number of admissions over 15 years old.

About 14% of the burden of disease in wealthier countries is attributable to smoking

The effects of the anti-smoking law are yet to be analyzed.

15

ArticlesCOPD|

ArticlesCOPD|

Socioeconomic Development Influence on COPD Mortality

[5] Chen, J., C. M. Schooling, et al. (2011).

16

Economic development may reduce vulnerability to COPD by reducing long-lasting

insults to the respiratory system, such as infections, poor nutrition and indoor air pollution.

Some of these gains may be offset if economic development results in increasing air

pollution or increasing smoking.

ArticlesCOPD|

[7] Han, M. K., D. Postma, et al. (2007).

[6] Patrascu, N. (2010).

17

Women may be at greater risk of smoking-induced lung function impairment for the same level of tobacco exposure.

Most studies have reported greater loss of lung function in women than men.

Differences exist between genders and this influences therapeutic management. Integrating this information is important to identify areas for future research.

Gender

ArticlesCOPD|

Gender

Chronic obstructive pulmonary disease (COPD) has historically been considered a

disease of older, white, male smokers.

In this study, the physicians more often diagnosed the women (incorrectly) as having

asthma, but the sex bias disappeared once they were shown spirometry results.

18

[8] Ohar, J., L. Fromer, et al. (2011).

COPD | Diseases of the Respiratory System (490-496)

[10] Quan, H., V. Sundararajan, et al. (2005). 19

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AN ALLIED CONDITIONS

494Bronchiectasis494.0 Bronchiectasis without acute axacerbation494.1 Bronchiectasis with acute exacerbation

495 Extrinsic allergic alveolitis

495.0 Farmers' lung495.1 Bagassosis495.2 Bird-fanciers' lung495.3 Suberosis495.4 Malt workers' lung495.5 Mushroom workers' lung495.6 Maple bark-strippers' lung495.7 "Ventilation" pneumonitis495.8 Other specified allergic alveolitis and pneumonitis495.9 Unspecified allergic alveolitis and pneumonitis

496 Chronic airway obsruction, not elsewhere classified

490 Bronchitis, not specified as acute or chronic491 Chronic bronchitis

491.0 Simple chronic bronchitis491.1 Mucopurulent chronic bronchitis491.2 Obstructive chronic bronchitis

491.20 Without exacerbation491.21 With (acute) exacerbation491.22 With acute bronchitis

491.8 Other chroni bronchitis491.9 Unspecified chronic bronchitis

492 Emphysema492.0 Emphysematous bleb492.8 Other emphysema

493 Asthma493.0 Extrinsic asthma493.1 Intrinsic asthma493.2 Chronic obstructive asthma493.8 Other forms of asthma

493.81 Exercise induced bronchospasm493.82 Cough variant asthma

493.9 Asthma, unspecified

COPD |

[10] Quan, H., V. Sundararajan, et al. (2005). 20

OPERATIONS ON THE RESPIRATORY SYSTEM (32-33)

32 Excision of lung and bronchusIncludes: -rib resection as operative approach; -sternotomy as operative approach; -sternum-splitting incision as …………….operative approach; -thoracotomy as operative approach.Code also any synchronous bronchoplasty (33.48)

33 Other operations on lung and ….bronchusIncludes: -rib resection as operative approach; -sternotomy as operative approach; -sternum-splitting incision as operative ………….approach; -thoracotomy as operative approach.

COPD |Justification

21

Prevalence in Portuguese Total number of admissions is not as significant as in other

countries

it is of extreme importance to determine how COPD have evolved in the last decade

No such synthesis study has yet been presented to the health care community in PORTUGAL

• Analyse and establish relationships between certain parameters

of COPD hospitalized patients’ such as:

Gender

Age

Residency (related environmental factors)

Length of stay

Surgical procedures

Admission by year and seasonal variations

Influence of the 2007 smoke-free law

Aims

RESEARCH QUESTION I How have trends in hospital

admissions of patients with COPD in portuguese public hospitals evolved over the last decade?

22

Study classification analytical observational

COPD |Methods

23

Study Classification

Research

Statistical Analysis

Exclusion factors:

absence of full text available

articles older than 1998

Articles that only mention “asthma” or “ chronic

bronchitis” or “emphysema”

Articles that didn’t have an explicit reference in

the title to “COPD”

COPD |Methods

Except Portuguese Articles

24

Research



Portuguese Health System – portuguese public hospital admissions data,

2000 – 2009

Selection of admissions with COPD (ICD-9-CM codes)

Gender

Age

Clinical History (ICD-9-CM codes for diagnosis and procedures)

Residency

Hospitalization

COPD |Methods

25

Research



Group ages – to allow a comparative analysis: 1. children 0 – 17 years

2. young adults 18 – 29 years

3. adults 30 – 64 years

4. elderly ≥ 65 years

COPD |Methods

26

Research



Statistical Analysis IBM SPSS Statistics 20

Hypothesis Tests

COPD |Methods

27

Research



[11] National Institute of Statistics.

28

COPD |Results

Gender

Age

Residency

Length of stay

Surgical procedures

Admission by year and seasonal

variations

Influence of 2007 smoke-free law

Some definitions...Some definitions...

Principal diagnosis: cause of admission.

Secondary diagnosis: other diagnostic that was

“made” while the patient was in the hospital,

due to other condition, but wasn’t the cause of

admission.

Admission: hospitalization.

29

COPD |Results

Gender

Age

Residency

Length of stay

Surgical procedures


variations

Influence of 2007 smoke-free law Chart 1 – Admission with COPD as principal diagnosis or

secondary (ICD-9-CM codes 490 – 496.xx) in mainland portuguese public hospitals 2000-2008

Total number of admissions related with COPD: 377 076

30

COPD |Results

GENDERGENDER

Age

Residency

Length of stay

Surgical procedures


variations


Chart 2– Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Admission per year and gender

Total number of admissions:

377 076


377 076

Num

ber o

f Adm

issi

ons

Year of admission

31

COPD |Results

GENDERGENDER

Age

Residency

Length of stay

Surgical procedures


variations


Year of admission per gender

32

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations


Chart 3– Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Admission per year and group of age


377 076


377 076

Group of ages:Children: 0-17Young adults: 18-29Adults: 30-64Elderly: ≥65


Num

ber o

f Adi

mis

sion

s

Year of admission

33

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations


Chart 4 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Number of cases in each group of age.


377 076


377 076



Age

34

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




35

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




36

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




37

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




38

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




39

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




40

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




41

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




42

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations




43

COPD |Results

Gender

AGEAGE

Residency

Length of stay

Surgical procedures


variations


Year of admission per age group

44

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations


North

Center

Alentejo

Algarve

Lisbon

Picture 7 –NUT II mainland Portuguese regions

45

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations


Chart 5 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Number of admissions per year of admission and NUT II region

Year of admission

Nu

mb

er o

f A

dim

issi

on

s


377 076


377 076

46

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations

Influence of 2007 smoke-free law Total number

of admissions:377 076


377 076

47

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

48

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

49

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

50

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

51

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

52

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

53

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

54

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations




377 076

55

COPD |Results

Gender

Age

RESIDENCYRESIDENCY

Length of stay

Surgical procedures


variations


56

COPD |Results

Gender

Age

Residency

LENGTH OF STAYLENGTH OF STAY

Surgical procedures


variations


Chart 6 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Length of stay

Length of Stay


377 076


377 076

57

COPD |Results

Gender

Age

Residency


Surgical procedures


variations


Chart 7 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Length of stay per year of admission

Me

d o

f le

ng

th o

f s

tay

(d

ay

s)

Year of admission


377 076


377 076

c cc c

COPD |Results

Gender

Age

Residency


Surgical procedures


variations


Chart 7 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Length of stay

Me

d o

f le

ng

th o

f s

tay

(d

ay

s)

Year of admission


377 076


377 07658

Kruskal-Wallis non-parametric test

Length of stay per year of admission: significance p<0,05

c cc c

59

COPD |Results

Gender

Age

Residency


Surgical procedures


variations


Children Young Adult Adult Elderly

Chart 8 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Length of stay in each age group

Mea

n of

leng

th o

f sta

y (d

ays)

Group of age


377 076


377 076

Group ages:Children: 0-17Young adults: 18-29Adults: 30-64Elderly: ≥65


c cc c

COPD |Results

Gender

Age

Residency


Surgical procedures


variations


Children Young Adult Adult Elderly

Chart 8 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Length of stay in each age group

Mea

n of

leng

th o

f sta

y (d

ays)

Group of age


377 076


377 076


Group ages:Children: 0-17Young adults: 18-29Adults: 30-64Elderly: ≥65 60

Kruskal-Wallis non-parametric test

Length of stay per age group: significance p<0,05

61

COPD |Results

Gender

Age

Residency


Surgical procedures


variations


Men Women

Med

of

len

gth

of

stay

(d

ays)

Chart 9 – Admission with COPD (ICD-9-CM codes 490 – 496.xx in principal or secondary diagnosis. Length of stay per gender.

Gender


377 076


377 076

COPD |Results

Gender

Age

Residency


Surgical procedures


variations


Men Women

Mea

n o

f le

ng

th o

f st

ay (

day

s)

Chart 9 – Admission with COPD (ICD-9-CM codes 490 – 496.xx in principal or secondary diagnosis. Length of stay per gender.

Gender


377 076


377 076 62

Mann-Whitney non-parametric test

Length of stay per gender: significance p<0,05

63

COPD |Results

Gender

Age

Residency

Length of stay

SURGICAL SURGICAL PROCEDURESPROCEDURES


variations


Chart 10 – Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal diagnosis or secondary diagnosis. Surgical procedures from 32.00 to 33.xx

Number of surgical procedures on the respiratory system:

14 818


14 818


377 076


377 076

64

COPD |Results

Gender

Age

Residency

Length of stay



variations


Lung transplantTotal

No Yes

Principal diagnosis

1 198 3 1 201

Secondary diagnosis

13 608 9 13 617

Total 14 806 12 14 818

Table 3– Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal diagnosis or secondary diagnosis that were submitted to any surgical procedure. Lung transplant (yes or no)


14 818


14 818


377 076


377 076

65

COPD |Results

Gender

Age

Residency

Length of stay



variations


Lung ExcisionTotal

No YesPrincipal diagnosis

961 240 1 201

Secondary diagnosis

10 820 2 797 13 617

Total11 781 3 037 14 818

Table 4– Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal diagnosis or secondary diagnosis that were submitted to any surgical procedure. Lung excision (yes or no)


14 818


14 818


377 076


377 076

66

COPD |Results

Gender

Age

Residency

Length of stay

Surgical procedures

ADMISSION BY ADMISSION BY YEAR AND YEAR AND

SEASONAL SEASONAL VARIATIONSVARIATIONS


Chart 11– Admission with COPD (ICD-9-CM codes 490 – 496.xx) as principal diagnosis or secondary diagnosis. Total of admissions per month (2000-2008)

Total number of admissions (principal diagnosis):

116 690

Total number of admissions (principal diagnosis):

116 690

Total number of admissions (secondary diagnosis):

268 685

Total number of admissions (secondary diagnosis):

268 685

67

COPD |Results

Gender

Age

Residency

Length of stay

Surgical procedures

ADMISSION BY ADMISSION BY YEAR AND YEAR AND

SEASONAL SEASONAL VARIATIONSVARIATIONS


Chart 12– Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Number of admissions per month and year (2000-2008).


377 076


377 076

2000

2001

2002

2003

2004

2005

2006

2007

2008

68

COPD |Results

Gender

Age

Residency

Length of stay

Surgical procedures


variations

INFLUENCE INFLUENCE OFOF 20072007 SMOKE-FREE SMOKE-FREE

LAWLAW

References

World Wide Web1.http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease#Signs_and_symptoms – Wikipédia “COPD”2. http://en.wikipedia.org/wiki/Spirometry - Wikipédia “Spirometry” 3. http://www.nlm.nih.gov/medlineplus/copdchronicobstructivepulmonarydisease.html - Medline4.http://medicosdeportugal.saude.sapo.pt/utentes/doencas_pulmonares/dia_mundial_da_dpoc_primeiro_tratamento_em_7_anos_para_a_dpoc_e_com_modo_de_actuacao_mais_rapido_chega_a_portugal – Médicos de Portugal5. www.paraquenaolhefalteoar.com/slpage_info.php?id=26. http://www.drpereira.com.br/dpoc.htm7.http://www.meteo.pt/pt/media/comunicadosimprensa/comunidetail.html?f=/pt/media/comunicadosimprensa/arquivo/2009/CI_clima_decada_2000_2009.html Instituto – Instituto Português de Meteorologia

69

Ana Luís Pimenta de Almeida FerreiraAna Luís Pimenta de Almeida FerreiraAna Raquel Torres PintoAna Raquel Torres PintoÂngelo Emanuel Martins Rodrigues NevesÂngelo Emanuel Martins Rodrigues NevesDiogo Alexandre Santos FerreiraDiogo Alexandre Santos FerreiraEduarda Maria de Oliveira Duarte Eduarda Maria de Oliveira Duarte Filipa Lima Carneiro Marques dos SantosFilipa Lima Carneiro Marques dos Santos

Inês Azevedo da Costa MaiaInês Azevedo da Costa MaiaInês Maria Rocha CarneiroInês Maria Rocha CarneiroJoão Pedro Marcos CalvãoJoão Pedro Marcos CalvãoJoão Pedro Rosa de OliveiraJoão Pedro Rosa de OliveiraMafalda da Costa Aguiar MouriscoMafalda da Costa Aguiar MouriscoMarta Isabel Maia de Andrade MoreiraMarta Isabel Maia de Andrade Moreira



References

Publications

[1] Foreman, M. G., L. Zhang, et al. (2011). "Early-onset chronic obstructive pulmonary disease is associated with female sex, maternal factors, and African American race in the COPDGene Study." Am J Respir Crit Care Med 184(4): 414-420.

[2] Rodgers, A., M. Ezzati, et al. (2004). "Distribution of major health risks: findings from the Global Burden of Disease study." PLoS Med 1(1): e27.

[4]Report from the portuguese national observatory of respiratory diseases 2009. Available from: http://www.ondr.org/relatorios_ondr.html

70

[3]World Health Organization (2011) Burden of Chronic respiratory disease. 2011.Available:http://www.who.int/respiratory/copd/burden/en/index.html.

[5] Chen, J., C. M. Schooling, et al. (2011). "How does socioeconomic development affect COPD mortality? An age-period-cohort analysis from a recently transitioned Total number of admissions in China." PLoS One 6(9): e24348.

References

Publications

[9] Borges, M., M. Gouveia, et al. (2009). "The burden of disease attributable to smoking in Portugal." Rev Port Pneumol 15(6): 951-1004.

[7] Han, M. K., D. Postma, et al. (2007). "Gender and chronic obstructive pulmonary disease: why it matters." Am J Respir Crit Care Med 176(12): 1179-1184.

[6] Patrascu, N. (2010). "Sex-related Differences of Chronic Obstructive Pulmonary Disease Impact on Life Quality: the Platino Study." Maedica (Buchar) 5(4): 307.

71

[8] Ohar, J., L. Fromer, et al. (2011). "Reconsidering sex-based stereotypes of COPD." Prim Care Respir J 20(4): 370-378.

[10] Quan, H., V. Sundararajan, et al. (2005). "Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data." Med Care 43(11): 1130-1139.



References

Publications

72

[13] Araújo AT. Epidemiologia da DPOC em Portugal e no mundo. Available from: http://www.paraquenaolhefalteoar.com/upload/File/Epidemiologia%20da%20DPOC%20em%20Portugal%20e%20no%20mundo.pdf

[12]World Health Organization (2011) Burden of Chronic respiratory disease. 2011.Available:http://www.who.int/respiratory/copd/burden/en/index.html.

[11] National Institute of Statistics. Available from: http://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_indicadores&indOcorrCod=0005889&contexto=pi&selTab=tab0



| Have C hronic O bstructive P ulmonary D isease admissions increased over the last decade?

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