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COPD is a leading cause of morbidity and mortality worldwide and
results in an economic and social burden that is both substantial and
increasing. COPD prevalence, morbidity, and mortality vary across countries and
across different groups within countries. COPD is the result of cumulative exposures
over decades. Often, the prevalence of COPD is directly related to the
prevalence of tobacco smoking, although in many countries, outdoor, occupational
and indoor air pollution – the latter resulting from the burning of wood and
other biomass fuels – are major COPD risk factors. The prevalence and burden of
COPD are projected to increase in the coming decades due to continued exposure
to COPD risk factors and the changing age structure of the world’s population
(with more people living longer and therefore expressing the long-term effects
of exposure to COPD risk factors). Information on the burden of COPD can be
found on international Websites such as those of the World Health Organization (WHO)
(http://www.who.int) and the World Bank/WHO Global Burden of Disease Study (http://www.who.int/topics/global_burden_of_disease).
Aging itself is a risk factor for COPD and aging of the airways and parenchyma
mimic some of the structural changes associated with COPD
Prevalence
Existing COPD prevalence data show remarkable variation due to
differences in survey methods, diagnostic criteria, and analytic approaches.
The lowest estimates of prevalence are those based on self-reporting of a
doctor diagnosis of COPD or equivalent condition. For example, most national
data show that less than 6% of the adult population has been told that they
have COPD. This likely reflects the widespread under-recognition and under diagnosis
of COPD. Despite the complexities, data are emerging that enable some conclusions
to be drawn regarding COPD prevalence, not least because of increasing data
quality control. A systematic review and meta-analysis of studies carried out
in 28 countries between 1990 and 2004, and an additional study from Japan,
provide evidence that the prevalence of COPD is appreciably higher in smokers and
ex-smokers than in nonsmokers, in those over 40 years of age than those under
40, and in men than in women. The Latin American Project for the Investigation of
Obstructive Lung Disease (PLATINO) examined the prevalence of
post-bronchodilator airflow limitation among persons over age 40 in five major
Latin American cities, each in a different country – Brazil, Chile, Mexico,
Uruguay, and Venezuela. In each country, the prevalence of COPD increased
steeply with age, with the highest prevalence among those over age 60, ranging
in the total population from a low of 7.8% in Mexico City, Mexico to a high of 19.7%
in Montevideo, Uruguay. In all cities/countries the prevalence was appreciably
higher in men than in women, which contrasts with findings from European cities
such as Salzburg. The Burden of Obstructive Lung Diseases program (BOLD) has
carried out surveys in several parts of the world and has documented more
severe disease than previously found and a substantial prevalence (3-11%) of COPD
among never-smokers.
Morbidity
Morbidity measures traditionally include physician visits, emergency
department visits, and hospitalizations. Although COPD databases for these
outcome parameters are less readily available and usually less reliable than mortality
databases, the limited data available indicate that morbidity due to COPD increases with age. Morbidity from COPD may
be affected by other comorbid chronic conditions (e.g.,cardiovascular disease,
musculoskeletal impairment, diabetes mellitus) that are related to COPD and may
have an impact on the patient’s health status, as well as interfere with COPD
management.
Mortality
The World Health Organization publishes mortality statistics for
selected causes of death annually for all WHO regions; additional information
is available from the WHO Evidence for Health Policy Department (http://www.who.int/evidence).
Data must be interpreted cautiously, however, because of inconsistent use of terminology
for COPD. In the 10th revision of the ICD, deaths from COPD or chronic airways
obstruction are included in the broad category of “COPD and allied conditions”
(ICD-10 codes J42-46). Under-recognition and under-diagnosis of COPD still affect
the accuracy of mortality data. Although COPD is often a primary cause of
death, it is more likely to be listed as a contributory cause of death or
omitted from the death certificate entirely. However, it is clear that COPD is
one of the most important causes of death in most countries. The Global Burden
of Disease Study projected that COPD, which ranked sixth as a cause of death in
1990, will become the third leading cause of death worldwide by 2020; a newer
projection estimated COPD will be the fourth leading cause of death in 2030.
This increased mortality is mainly driven by the expanding epidemic of smoking,
reduced mortality from other common causes of death (e.g. ischemic heart
disease, infectious diseases), and aging of the world population.
Economic Burden
COPD is associated with significant economic burden. In the
European Union, the total direct costs of respiratory disease are estimated to be
about 6% of the total health care budget, with COPD accounting for 56% (38.6
billion Euros) of this cost of respiratory disease. In the United States the estimated direct costs of COPD are $29.5 billion and
the indirect costs $20.4 billion. COPD exacerbations account for the greatest
proportion of the total COPD burden on the health care system. Not
surprisingly, there is a striking direct relationship between the severity of
COPD and the cost of care, and the distribution of costs changes as the disease
progresses. For example, hospitalization and ambulatory oxygen costs soar as
COPD severity increases. Any estimate of direct medical expenditures for home
care under-represents the true cost of home care to society, because it ignores
the economic value of the care provided to those with COPD by family members. In
developing countries, direct medical costs may be less important than the impact
of COPD on workplace and home productivity. Because the health care sector
might not provide long-term supportive care services for severely disabled
individuals, COPD may force two individuals to leave the workplace—the affected
individual and a family member who must now stay home to care for the disabled relative.
Since human capital is often the most important national asset for developing
countries, the indirect costs of COPD may represent a serious threat to their
economies.
Social Burden
Since mortality offers a limited perspective on the human burden
of a disease, it is desirable to find other measures of disease burden that are
consistent and measurable across nations. The authors of the Global Burden of Disease
Study designed a method to estimate the fraction of mortality and disability
attributable to major diseases and injuries using a composite measure of the
burden of each health problem, the Disability-Adjusted Life Year (DALY). The
DALYs for a specific condition are the sum of years lost because of premature
mortality and years of life lived with disability, adjusted for the severity of
disability. In 1990, COPD was the twelfth leading cause of DALYs lost in the
world, responsible for 2.1% of the total. According to the projections, COPD
will be the seventh leading cause of DALYs lost worldwide in 2030.
Mark: Above content is from Global
Initiative for Chronic Obstructive Lung Disease 2014
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