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

| Have C hronic O bstructive P ulmonary D isease admissions increased over the last decade?. Class 10 | Introdução à Medicina | 2011/2012. COPD |. Associated Pathologies. Picture 1. Organizational Chart 1 – Co-occurrence of emphysema, asthma and chronic bronchitis in COPD. COPD |.

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

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  1. | Have Chronic Obstructive Pulmonary Disease admissions increased over the last decade? Class 10 | Introdução à Medicina | 2011/2012

  2. COPD | Associated Pathologies Picture 1 Organizational Chart 1 – Co-occurrence of emphysema, asthma and chronic bronchitis in COPD

  3. COPD | Triggering Factors 3 1 Smoke Air Pollution 2 Picture 2 Genetics 3 [1] Foreman, M. G., L. Zhang, et al. (2011).

  4. COPD | Symptoms ✓ Limitation of the flow of air to and from the lungs 1 Hemoptysis 2 3 Hyperinflation 4 Sputum 5 Dyspnea Picture 3

  5. COPD | Symptoms Limitation of the flow of air to and from the lungs 1 ✓ Hemoptysis 2 3 Hyperinflation 4 Sputum 5 Dyspnea Picture 4

  6. COPD | Symptoms Limitation of the flow of air to and from the lungs 1 Hemoptysis 2 ✓ 3 Hyperinflation 4 Sputum 5 Dyspnea Picture 5 6

  7. COPD | Symptoms Limitation of the flow of air to and from the lungs 1 Hemoptysis 2 3 Hyperinflation ✓ 4 Sputum 5 Dyspnea 7

  8. COPD | Symptoms Limitation of the flow of air to and from the lungs 1 Hemoptysis 2 3 Hyperinflation 4 Sputum ✓ 5 Dyspnea 8

  9. COPD| Ideal steps in clinical practice Early Diagnosis. Treatment Picture 8 Favorable Prognosis 9

  10. COPD| Treatments Quit smoking 1 Oxygen therapy 2 Pharmaceutical treatment 3 4 Surgery Picture 6 10

  11. COPD | Symptomatic Cases [2] Rodgers, A., M. Ezzati, et al. (2004). 1,3 1,5 2,0 2,2 3,0 4,2 5,7 7,2 Table 1 – COPD place among main death causes in developed countries 11

  12. COPD | Symptomatic Cases [2] Rodgers, A., M. Ezzati, et al. (2004). [3]World Health Organization (2011) Burden of Chronic respiratory disease. 2011. “ 1,3 210 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. 1,5 2,0 2,2 3,0 ” 4,2 5,7 7,2 Table 1 – COPD place among main death causes in developed countries 12

  13. 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.

  14. COPD| Articles Report from the portuguese national observatory of respiratory diseases • 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). [4]Report from the portuguese national observatory of respiratory diseases 2009 14

  15. COPD| Articles The burden of disease attributable to smoking in Portugal • 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. [9] Borges, M., M. Gouveia, et al. (2009). 15

  16. COPD| Articles Socioeconomic Development Influence on COPD Mortality  • 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. [5] Chen, J., C. M. Schooling, et al. (2011). 16

  17. COPD| Articles Gender • Womenmaybeatgreaterriskof smoking-inducedlungfunctionimpairment for thesameleveloftobaccoexposure. • Moststudieshavereportedgreaterlossoflungfunction in womenthanmen. [6] Patrascu, N. (2010). • Differences exist between genders and this influences therapeutic management. Integrating this information is important to identify areas for future research. [7] Han, M. K., D. Postma, et al. (2007). 17

  18. COPD| Articles 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. [8] Ohar, J., L. Fromer, et al. (2011). 18

  19. COPD | Diseases of the Respiratory System (490-496) CHRONIC OBSTRUCTIVE PULMONARY DISEASE AN ALLIED CONDITIONS 19 [10] Quan, H., V. Sundararajan, et al. (2005).

  20. COPD | OPERATIONS ON THE RESPIRATORY SYSTEM (32-33) 20 [10] Quan, H., V. Sundararajan, et al. (2005).

  21. COPD | Justification Prevalence in Portuguese Total number of admissions is not as significant as in other countries BUT 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 21

  22. RESEARCH QUESTION IHow have trends in hospital admissions of patients with COPD in portuguese public hospitals evolved over the last decade? Aims • 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 22

  23. COPD | Methods Study classification • analytical • observational Study Classification Research Statistical Analysis 23

  24. COPD | Methods 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” Study Classification Research Statistical Analysis Except Portuguese Articles 24

  25. COPD | Methods 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 Study Classification Research Statistical Analysis 25

  26. COPD | Methods Group ages – to allow a comparative analysis: • children 0 – 17 years • young adults 18 – 29 years • adults 30 – 64 years • elderly ≥ 65 years Study Classification Research Statistical Analysis 26

  27. COPD | Methods Statistical Analysis • IBM SPSS Statistics 20 Hypothesis Tests Study Classification Research Statistical Analysis [11] National Institute of Statistics. 27

  28. Some definitions... COPD | Results 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. Gender Age Residency Length of stay Surgical procedures Admission by year and seasonal variations Influence of 2007 smoke-free law 28

  29. Total number of admissions related with COPD: 377 076 COPD | Results Gender Age Residency Length of stay Surgical procedures Admission by year and seasonal variations Influence of 2007 smoke-free law 116 690 268 685 Chart 1 – Admission with COPD as principal diagnosis or secondary (ICD-9-CM codes 490 – 496.xx) in mainland portuguese public hospitals 2000-2008 29

  30. COPD | Results GENDER Age Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Number of Admissions Year of admission 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 30

  31.  Statistical Analysis COPD | Results GENDER Age Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Year of admission per gender 31

  32. COPD | Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law NumberofAdimissions Year of admission Chart 3– Admission with COPD (ICD-9-CM codes 490 – 496.xx) in principal or secondary diagnosis. Admission per year and group of age Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 Total number of admissions: 377 076 32

  33. COPD | Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Age 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. Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 Total number of admissions: 377 076 33

  34. COPD | Children Number of admissions:2 627 Number of citizens:1 913 580 0.13% Young Adults Number of admissions:1 095 Number of citizens:1 783 062 0.06% Adults Number of admissions:9 905 Number of citizens:4 468 045 0.22% Elderly Number of admissions:22 801 Number of citizens:1 615 158 1.4% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 34

  35. COPD | Children Number of admissions: 2 769 Number of citizens:1 899 298 0.15% Young Adults Number of admissions:1 154 Number of citizens:1 776 443 0.06% Adults Number of admissions:10 598 Number of citizens:4 530 088 0.23% Elderly Number of admissions:25 144 Number of citizens:1 645 595 1.5% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 35

  36. COPD | Children Number of admissions:2 587 Number of citizens:1 891 763 0.14% Young Adults Number of admissions:1 325 Number of citizens:1 764 394 0.08% Adults Number of admissions:11 289 Number of citizens:4 598 585 0.25% Elderly Number of admissions:26 879 Number of citizens:1 672 663 1.6% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 36

  37. COPD | Children Number of admissions:2 739 Number of citizens:1 889 083 0.14% Young Adults Number of admissions:1 450 Number of citizens:1 742 083 0.08% Adults Number of admissions:11 930 Number of citizens:4 661 488 0.26% Elderly Number of admissions:28 478 Number of citizens:1 699 000 1.7% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 37

  38. COPD | Children Number of admissions:2 711 Number of citizens:1 883 474 0.15% Young Adults Number of admissions:1 269 Number of citizens:1 705 910 0.07% Adults Number of admissions:11 608 Number of citizens:4 726 158 0.25% Elderly Number of admissions:29 147 Number of citizens:1 728 221 1.7% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 38

  39. COPD | Children Number of admissions:2 407 Number of citizens:1 880 356 0.13% Young Adults Number of admissions:1 246 Number of citizens:1 659 216 0.08% Adults Number of admissions:12 107 Number of citizens:4 794 862 0.25% Elderly Number of admissions:31 306 Number of citizens:1 747 720 1.8% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 39

  40. COPD | Children Number of admissions:2 871 Number of citizens:1 874 754 0.15% Young Adults Number of admissions:1 212 Number of citizens:1 615 179 0.08% Adults Number of admissions:12 352 Number of citizens:4 854 193 0.25% Elderly Number of admissions:30 846 Number of citizens:1 766 145 1.7% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 40

  41. COPD | Children Number of admissions:2 352 Number of citizens:1 864 456 0.13% Young Adults Number of admissions:1 341 Number of citizens:1 572 980 0.09% Adults Number of admissions:13 123 Number of citizens:4 902 100 0.27% Elderly Number of admissions:33 920 Number of citizens:1 787 344 1.9% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 41

  42. COPD | Children Number of admissions:2 279 Number of citizens:1 853 503 0.12% Young Adults Number of admissions:1 261 Number of citizens:1 535 499 0.08% Adults Number of admissions:12 983 Number of citizens:4 934 656 0.26% Elderly Number of admissions:33 777 Number of citizens:1 811 651 1.8% Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Group of ages: Children: 0-17 Young adults: 18-29 Adults: 30-64 Elderly: ≥65 42

  43.  Statistical Analysis COPD | Results Gender AGE Residency Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Year of admission per age group 43

  44. COPD | North Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Center Lisbon Alentejo Algarve Picture 7 –NUT II mainland Portuguese regions 44

  45. COPD | Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Number of Adimissions Year of admission 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 Total number of admissions: 377 076 45

  46. COPD | North Number of admissions:11 766 Number of citizens: 3 643 795 0.32% Center Number of admissions:8 767 Number of citizens:2 325 161 0.37% Lisbon Number of admissions:10 704 Number of citizens:2 661 748 0.4% Alentejo Number of admissions:2 260 Number of citizens:765 742 0.3% Algarve Number of admissions:784 Number of citizens:383 399 0.2% Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Total number of admissions: 377 076 46

  47. COPD | North Number of admissions:12 898 Number of citizens:3 667 529 0.35% Center Number of admissions:9 444 Number of citizens:2 339 561 0.4% Lisbon Number of admissions:11 401 Number of citizens:2 686 872 0.42% Alentejo Number of admissions:2 340 Number of citizens:766 529 0.3% Algarve Number of admissions:1 021 Number of citizens:390 933 0.26% Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Total number of admissions: 377 076 47

  48. COPD | North Number of admissions:13 839 Number of citizens:3 691 922 0.37% Center Number of admissions:9 874 Number of citizens:2 354 552 0.41% Lisbon Number of admissions:11 947 Number of citizens:271 461 0.44% Alentejo Number of admissions:2 374 Number of citizens:767 983 0.31% Algarve Number of admissions:1 223 Number of citizens:398 370 0.31% Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Total number of admissions: 377 076 48

  49. COPD | North Number of admissions:13 839 Number of citizens:3 711 797 0.37% Center Number of admissions:9 874 Number of citizens:2 366 691 0.42% Lisbon Number of admissions:12 645 Number of citizens:2 740 237 0.46% Alentejo Number of admissions:2 449 Number of citizens:767 549 0.32% Algarve Number of admissions:1 163 Number of citizens:405 380 0.29% Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Total number of admissions: 377 076 49

  50. COPD | North Number of admissions:15 068 Number of citizens:372 731 0.4% Center Number of admissions:10 279 Number of citizens:2 376 609 0.43% Lisbon Number of admissions:12 523 Number of citizens:2 760 697 0.45% Alentejo Number of admissions:2 510 Number of citizens:767 679 0.32% Algarve Number of admissions:1 035 Number of citizens:411 468 0.25% Results Gender Age RESIDENCY Length of stay Surgicalprocedures Admission by year and seasonal variations Influence of 2007 smoke-free law Total number of admissions: 377 076 50

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