Prevalence and risk factors of chronic obstructive pulmonary disease in Anhui Province, China: a population-based survey.
ABSTRACT: BACKGROUND:The prevalence of chronic obstructive pulmonary disease (COPD) in Anhui Province of eastern China remain uncertain. The present study provides the first estimate of the prevalence and risk factors of COPD in Anhui. METHODS:A population-based survey was conducted in a representative sample of population aged 40?years or older in 2015. COPD was diagnosed based on 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. RESULTS:A total of 2770 participants had reliable post-bronchodilator results and were included in the final analysis. The overall prevalence of COPD was 9.8% (95% CI: 8.2, 11.7). Prevalence was higher in men (14.8, 95% CI: 12.6, 17.2) than it was in women (5.2, 95% CI: 3.1, 8.7). Among adults with COPD, 45.0% (95% CI: 39.1, 51.0) had moderate or severe disease (GOLD stage II-IV), 0.7% (95% CI: 0.2, 2.9) reported that they had a previous pulmonary function test, and only 0.4% (95% CI: 0.1, 2.6) knew their diagnosis of COPD. Risk factors for COPD included older age (OR 1.06, 95% CI: 1.04, 1.08), male sex (OR 2.01, 95% CI: 1.22, 3.33), current smoking status (OR 2.63, 95% CI: 1.86, 3.73), primary school or lower education (OR 1.61, 95% CI: 1.12, 2.31), family history of lung disease (OR 1.50, 95% CI: 1.17, 1.93), and indoor exposure to coal for cooking or heating (OR 1.55, 95% CI: 1.11, 2.15). In addition, people in north region has a significantly higher risk for developing COPD than people in south region of Anhui (OR 1.98, 95% CI:1.44, 2.71). CONCLUSIONS:COPD is prevalent in Anhui and the prevalence is highest in north region. Strategies aiming at prevention, early detection and treatment of COPD are urgently needed to reduce COPD-related burden.
Project description:<h4>Background</h4>Because of the rapid change in economic development and lifestyle in China, and the ageing population, concerns have grown that chronic obstructive pulmonary disease (COPD) could become epidemic. An up-to-date nationwide estimation of COPD prevalence in China is needed.<h4>Methods</h4>We did a cross-sectional survey of a nationally representative sample of individuals from mainland China aged 40 years or older. The primary outcome was COPD, defined according to the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) lung function criteria.<h4>Findings</h4>Between Dec 29, 2014, and Dec 31, 2015, 66?752 adults were recruited to the study population. The estimated standardised prevalence of COPD was 13·6% (95% CI 12·0-15·2). The prevalence of COPD differed significantly between men and women (19·0%, 95% CI 16·9-21·2 vs 8·1%, 6·8-9·3; p<0·0001), mainly because of a significant difference in smoking status between men and women (current smokers 58·2% vs 4·0%). The prevalence of COPD differed by geographic region, with the highest prevalence in southwest China (20·2%, 95% CI 14·7-25·8) and the lowest in central China (10·2%, 8·2-12·2). Among adults with COPD, 56·4% (95% CI 53·7-59·2) had mild disease (GOLD stage I), 36·3% (34·3-38·3) had moderate disease (GOLD stage II), 6·5% (5·5-7·4) had severe disease (GOLD stage III), and 0·9% (0·6-1·1) had very severe disease (GOLD stage IV).<h4>Interpretation</h4>In a large, nationally representative sample of adults aged 40 years or older, the estimated overall prevalence of COPD in China in 2014-15 was 13·6%, indicating that this disease has become a major public-health problem. Strategies aimed at prevention and treatment of COPD are needed urgently.<h4>Funding</h4>Chinese Central Government, the Ministry of Science and Technology of The People's Republic of China, and the National Natural Science Foundation of China.
Project description:Presence of chronic obstructive pulmonary disease (COPD) in heart failure (HF) has prognostic and therapeutic implications. Exact prevalence estimates are lacking because most previous studies estimated the prevalence of COPD among HF patients while unstable and in the presence of pulmonary congestion.Community-dwelling patients with an established diagnosis of HF and in a stable phase of their disease were invited for spirometry. COPD was defined according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification and considered present if the ratio of the post-bronchodilator forced expiratory volume in 1 second and forced vital capacity was below 0.7.Thirty of the 106 patients with HF (mean age 76 [standard deviation] 11.9 years, 57% male) had COPD (prevalence 28.3% [95% confidence interval (CI) 19.7%-36.9%]), with similar rates among those with HF and a reduced ejection fraction (18 individuals; prevalence 28.6% [95% CI 20.0%-37.2%]) and HF with preserved ejection fraction (12 individuals; prevalence 27.9% [95% CI 19.4-36.4]). Twenty-one (70%) of the 30 participants were newly detected cases of COPD.More than a quarter of the patients with HF concomitantly have COPD, with the large majority being previously unrecognized. Coexistence of COPD should be considered more often in these patients.
Project description:<b>Aim of Study:</b> Four hundred million people live at high altitude worldwide. Prevalence and risk factors for COPD in these populations are poorly documented. We examined the prevalence and risk factors for COPD in residents living at an altitude of 2,100-4,700 m. <b>Methods:</b> We performed a cross-sectional survey in Xinjiang and Tibet autonomous region. A multistage stratified sampling procedure was used to select a representative population aged 15 years or older from eight high altitude regions. All participants underwent pre- and post-bronchodilator measurement of forced expiratory volumes. COPD was diagnosed according to 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. <b>Results:</b> Between June, 2015 and August 2016, 4,967 subjects were included. Median age was 38.0 years (range: 15-91 years; inter-quartile range: 28-49 years); 51.4% participants were female. Overall prevalence of spirometry-defined COPD was 8.2% (95% CI 7.4-8.9%): 9.3% in male (95% CI 8.2-10.4%), and 7.1% in female (95% CI 6.1-8.2%). By multivariable logistic regression analysis, COPD was significantly associated with being aged ?40 years (odds ratio: 2.25 [95% CI 1.72-2.95], <i>P</i> < 0.0001), exposure to household air pollution (OR: 1.34 [95% CI 1.01-1.79], <i>P</i> = 0.043), and a history of tuberculosis (OR: 1.79 [95% CI 1.23-2.61], <i>P</i> = 0.030), while living at a higher altitude (OR: 0.45 [95% CI 0.33-0.61], <i>P</i> < 0.0001) and having a higher educational level (OR: 0.64 [95% CI 0.43-0.95], <i>P</i> = 0.025) were associated with a lower prevalence of COPD. <b>Conclusions:</b> Our results show that the spirometry-defined COPD is a considerable health problem for residents living at high altitudes and COPD prevalence was inversely correlated with altitude. Preventing exposure to household air pollution and reducing the incidence of tuberculosis should be public health priorities for high altitude residents.
Project description:BACKGROUND:Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. The study aimed to determine and compare the prevalence of COPD in the general population aged 45-74 years old according to fixed ratio and lower limit of normal (LLN) thresholds in four cities in the Southern Cone of Latin America. METHODS:The Pulmonary Risk in South America (PRISA) study used a 4-stage stratified sampling method to select 5814 participants from 4 cities in the Southern Cone of Latin America (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Data on demographic information, medical history, risk factors, pre-bronchodilator and post-bronchodilator spirometry were obtained using a standard protocol. According to GOLD, COPD was defined as a post-bronchodilator ratio of forced expiratory volume in one second (FEV1) over forced vital capacity (FVC) less than 70%. The LLN threshold was defined as the lower fifth percentile for predicted FEV1/FVC, and was evaluated as an alternative COPD definition. RESULTS:Overall COPD prevalence was 9.3% (95% CI 8.4, 10.2%), and men had a higher prevalence [11.8% (95% CI 10.3, 13.3%)] than women [7.3% (95% CI 6.2, 8.3%)] with the fixed ratio. Overall COPD prevalence using LLN was 4.7% (95% CI 4.1, 5.3%), higher in men: 5.8% (95% CI 4.7, 6.8%) than women: 3.9% (95% CI 3.1, 4.7%). COPD prevalence was significantly higher among those who were older, had <high-school education and lower body-mass index, were cigarette smokers, and had self-reported history of asthma and tuberculosis. CONCLUSIONS:First, COPD and its risk factors are highly prevalent in the general population of Argentina, Chile, and Uruguay. Second, the prevalence of COPD by LLN criterion was significantly lower with lesser degrees of severity compared to fixed ratio of FEV1/FVC. Implementing LLN criterion instead of fixed ratio of FEV1/FVC may reduce the risk of over-diagnosis of COPD, although further prognostic studies of COPD adverse outcomes should be conducted using both definitions. Third, these data suggest that national efforts on the prevention, treatment, and control of COPD should be a public health priority in the Southern Cone of Latin America.
Project description:Hypoxemia is associated with worse outcomes in COPD. The aim of the study was to investigate the prevalence, incidence, and risk factors of hypoxic respiratory failure (HRF) in COPD.This was a longitudinal analysis of data from the Swedish National Register of COPD. HRF was defined as resting saturation ≤88% or long-term oxygen therapy. Risk factors for developing HRF were analyzed using multiple logistic regression and receiver operating characteristic curve analysis.A total of 3,061 patients were included; mean forced expiratory volume in 1 second was 1.47 L; mean age was 70 years; and 54% were females. Median follow-up time was 1.8 years (interquartile range 1.3-2.4 years). HRF was present in 43 (1.4%) patients at baseline and 74 (2.4%) patients at follow-up. Among patients without HRF at baseline, 49 (1.6%) developed HRF during follow-up. The risk was highest for patients in Global initiative for Chronic Obstructive Lung Disease (GOLD) 2017 stage IV or groups C or D at baseline. Developing HRF was independently predicted by lower forced expiratory volume in 1 second and lower COPD Assessment Test score, with a c-statistic of 0.84 (95% CI, 0.70-0.91). When the multivariable model used the GOLD 2017 variables stages I-IV and the dichotomized variables frequent exacerbations and COPD Assessment Test ≥10; the c-statistic increased slightly to 0.86 (95% CI, 0.80-0.92; P<0.0001).In patients with COPD, the prevalence and incidence of HRF was low and was predicted well by more severe air flow limitation and worse health status. The risk is highest in patients with GOLD stage IV and GOLD groups C or D.
Project description:<h4>Study objectives</h4>To undertake a meta-analysis of literature comparing the prevalence of cardiovascular and cerebrovascular comorbidities between patients with overlap syndrome (OS) and patients with chronic obstructive pulmonary disease (COPD) or patients with obstructive sleep apnea.<h4>Methods</h4>Studies about the cardiovascular and cerebrovascular disease of OS were searched for among several electronic databases from the time of database construction to June 2019. Two independent reviewers performed the process of study screening, quality assessment, and data extraction. Meta-analysis of odds ratios (ORs) was carried out by RevMan5.3 under either fixed-effects or random-effects models. Sensitivity analysis was conducted to examine the robustness of pooled outcome.<h4>Results</h4>A total of 17 articles were included. Compared with COPD/obstructive sleep apnea, OS significantly increased the risk of developing hypertension (OS vs COPD: OR = 1.94, 95% confidence interval [CI] [1.49, 2.52]; OS vs obstructive sleep apnea: OR = 2.05, 95% CI [1.57, 2.68]) and pulmonary hypertension (OS vs COPD: OR = 2.96, 95% CI [1.30, 6.77]; OS vs obstructive sleep apnea: OR = 5.93, 95% CI [1.84, 18.42]). There was no significant difference in the prevalence of coronary heart disease (OR = 1.19, 95% CI [.67,2.11]) and cerebrovascular disease (OR = 2.43, 95% CI [0.81, 7.31]) between patients with COPD and patients with OS. However, the sensitivity analysis showed that the pooled outcome of the comparison of pulmonary arterial pressure between patients with OS and patients with COPD was not stable.<h4>Conclusions</h4>OS significantly increased cardiovascular risk including the prevalence of hypertension and pulmonary hypertension. However, since the pooled outcome about pulmonary arterial pressure was not stable, further studies are still required.
Project description:Chronic obstructive pulmonary disease (COPD) is set to become the third most frequent cause of death and also the third largest cause of global morbidity by 2020. In China, where the population is aging rapidly, COPD has become one of the leading causes of disability and a large economic burden. An epidemiological assessment of the COPD in China is required, with a focus on the number of cases living with disease, main determinants of the disease and time trends.We systematically searched large Chinese bibliographic databases and English databases to identify spirometry-based epidemiological studies of the prevalence of COPD in China diagnosed according to GOLD criteria. We estimated age- and gender-specific prevalence of COPD using a multilevel mixed-effect logistic regression. We also presented the time trends of COPD between 1990 and 2010 by age, gender and setting (urban vs rural).In 1990, the prevalence of COPD ranged from 0.49% (95% CI?=?0.29-0.85) in <20 years group to 20.95% (95% CI?=?14.04-27.04) in>?=?80 years group, and the crude prevalence for China was 2.70% (95% CI?=?1.86-3.51). In 2010, the prevalence in <20 years was 0.55% (95% CI?=?0.37-1.04) and in>?=?80 years was 22.89% (95% CI?=?18.13-28.96), with the crude prevalence for China of 3.84% (95% CI?=?3.30-4.77). The COPD prevalence in males was about two-fold higher than in females, and it increased with increasing age. Between 1990-2010, the total number of Chinese people living with COPD increased by 66.73%, from 30.90 million (95% CI?=?21.28-40.02) in 1990 to 51.52 million (95% CI?=?44.26-63.93) in 2010. This increase was most striking in middle age, and greater in females than in males from 30 years up to 64 years. Our estimates, which used an independent approach to acquiring data and development of analytical methods, and were based on a more complete data set, are remarkably similar to those produced recently by the GBD 2013 collaboration, differing by only about 5% in the estimated number of COPD cases in 1990 and by 1% in 2010.COPD is a highly prevalent disease in China and its importance is growing steadily. The number of people living with COPD has increased substantially between 1990 and 2010. COPD is more frequent in males and in rural areas. Optimised primary and secondary prevention and treatment is urgently needed to counter this growing trend. Improved epidemiological studies will be required to assist development of more effective strategies of prevention and treatment of COPD in China in the next decade and beyond.
Project description:We aimed to investigate (1) the relationship between cognitive impairment (CI) and disease severity and (2) the potential differences in exercise performance, daily activities, health status, and psychological well-being between patients with and without CI. Clinically stable chronic obstructive pulmonary disease (COPD) patients, referred for pulmonary rehabilitation, underwent a neuropsychological examination. Functional exercise capacity (6-minute walk test [6MWT]), daily activities (Canadian Occupational Performance Measure [COPM]), health status (COPD Assessment Test [CAT]) and St George's Respiratory Questionnaire-COPD specific [SGRQ-C]), and psychological well-being (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory [BDI], and Symptom Checklist 90 [SCL-90]) were compared between patients with and without CI. Of 183 COPD patients (mean age 63.6 (9.4) years, FEV<sub>1</sub> 54.8 (23.0%) predicted), 76 (41.5%) patients had CI. The prevalence was comparable across Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4 (44.8%, 40.0%, 41.0%, 43.5%, respectively, p = 0.97) and GOLD groups A-D (50.0%, 44.7%, 33.3%, 40.2%, respectively, p = 0.91). Patients with and without CI were comparable for demographics, smoking status, FEV<sub>1</sub>% predicted, mMRC, 6MWT, COPM, CAT, HADS, BDI, and SCL-90 scores. Clinical characteristics of COPD patients with and without CI are comparable. Assessment of CI in COPD, thus, requires an active case-finding approach.
Project description:Infectious diarrhea cases have increased during the past years in the Anhui Province of China, but little is known about its spatial cluster pattern and associated socioeconomic factors. We obtained county-level total cases of infectious diarrhea in 105 counties of Anhui in 2016 and computed age-adjusted rates. Socioeconomic factors were collected from the Statistical Yearbook. Hot spot analysis was used to identify hot and cold spot counties for infectious diarrhea incidence. We then applied binary logistic regression models to determine the association between socioeconomic factors and hot spot or cold spot clustering risk. Hot spot analysis indicated there were both significant hot spot (29 counties) and cold spot (18 counties) clustering areas for infectious diarrhea in Anhui (P < 0.10). Multivariate binary logistic regression results showed that infectious diarrhea hot spots were positively associated with per capita gross domestic product (GDP), with an adjusted odds ratio (AOR): 3.51, 95% CI: 2.09-5.91, whereas cold spots clustering were positively associated with the number of medical staffs (AOR: 1.18, 95% CI: 1.08-1.29) and negatively associated with the number of public health physicians (AOR: 0.27, 95% CI: 0.09-0.86). We identified locations for hot and cold spot clusters of infectious diarrhea incidence in Anhui, and the clustering risks were significantly associated with health workforce resources and the regional economic development. Targeted interventions should be carried out with considerations of regional socioeconomic conditions.