Burden of Chronic Diseases COPD. Dr Randeep Guleria M.D, D.M. (Pulmonary Medicine) Professor Department of Medicine A.I.I.M.S

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1 Burden of Chronic Diseases COPD Dr Randeep Guleria M.D, D.M. (Pulmonary Medicine) Professor Department of Medicine A.I.I.M.S

2 Definition Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. GOLD 2007

3 Percent Change in Age-Adjusted Death Rates, U.S., Proportion of 1965 Rate Coronary Heart Disease Stroke Other CVD COPD All Other Causes % % % % %

4 The Burden of COPD: Death COPD will be the largest cause of death due to respiratory disease in the year 2020 Global Deaths (millions) COPD Respiratory Infections Tuberculosis Lower Respiratory Cancers Asthma Ref: Murray & Lopez, 1996

5 The Burden of COPD: Disability COPD will be the largest cause of disability due to respiratory disease in the year 2020 Global DALYs (millions COPD Respiratory Infections Tuberculosis Lower Respiratory Cancers Asthma Ref: Murray & Lopez, 1996

6 Facts About COPD COPD is the 4 th leading cause of death in the United States (behind heart disease, cancer, and cerebrovascular disease) By 2020 COPD will rise from its current ranking as the 12th most prevalent disease worldwide to the 5th and from the 6th most common cause of death to the 3rd

7 Burden of COPD WHO estimates 80 million people have moderate to severe COPD More than 3 million people died in % of all deaths globally Most information is from high income countries and epidemiological data at time is not uniform or accurate Burden of COPD is underestimated - not usually recognized and diagnosed until it is clinically apparent and moderately advanced Global burden of COPD will increase enormously as the toll from tobacco use in developing countries becomes apparent

8 COPD: underdiagnosis NHANES Study, Mannino et al, Arch Int Med 2000; 160:

9 COPD 1990 Prevalence Male/1000 Female/1000 n Established Market Economies n Formerly Socialist Economies n India n China n Other Asia and Islands n Sub-Saharan Africa n Latin America and Caribbean n Middle Eastern Crescent n World *From Murray & Lopez, 1996

10 Prevalence of COPD and its association with smoking as shown by the various population studies from India Author/s (year) Population Men (%) Women (%) M.F. ratio Wig et. al. 1964) Delhi (rural Sikand et al. (1966) Delhi Viswanathan (1966) Patna Bhattacharya et al. (1975) UP (rural) Radha et al. (1977) New Delhi Thiruvengadam et. Al. (1977) Viswanathan and Singh (1977 ) Madras (now Chennai) Delhi (rural) Delhi (urban) Smoker: nonsmoker ratio Charan (1977) Punjab (rural) Malik (1986 ) Jindal (1993) North India (rural) North India (Urban) North India (rural) North India (Urban) Ray et al. (1995 ) South India

11 Methodology and survey samples of different published reports on field prevalence Up to 1970 Authors No. of subjects surveyed Known smoking status (males) Method of study COPD diagnosis 1. Wig et al (1964) Age distributio n Sex distribution M F Smokers Non-smoker 0 to Interview Clinical exam & CXR 2. Viswanathan (1966) 3. Sikand et al (1966) 0 to Not mentioned Questionnair e 15 to Miniature X- ray; symptom inquiry Symptoms Radiological Jindal et al Indian J chest Dis Allied Sci 2

12 Methodology and survey samples of different published reports on field prevalence 1971 to 1990 Author smokers s 1. Bhattacharya et al (1975) Age males females non smokers method diagnosis 30 to Questionnaire Symptoms 2. Viswanathan & Singh (1977) 5 to Questionnaire Symptoms 3. Thiruvengadam et al (1977) 5 to Interview Symptoms 4. Charan (1977) 16 to Not known Questionnaire Symptoms 5. Radha et al (1977) 3 to Questionnaire and PEF Symptoms 6. Malik (1986) 15 to Questionnaire and PEF Clinical

13 Methodology and survey samples of different published reports on field prevalence After 1990 Author s 1. Jindal (1993) Ray at al (1995) Age dist. Male Female Smoker s Non smoker s method 15 to Questionnair e Questionnair e Diagnosi s Clinical symptom s Jindal et al Indian J chest Dis Allied Sci 20

14 Prevalence of COPD changes over the year (%) Period Males Females Up to After Average

15 Estimation of national burden of COPD (Total numbers/burden are expressed in millions) Census year Up to After Overall (Pooled) 1996 Total population In millions) Sex Radio (male. Female) : : :927 Number (in millions) Male Adults 30 yrs Total population (in millions) Male Female COPD 30 yrs) (1)Percent prevalence (2)Male (3)Female % 2.7% (b) Total burden (in millions) Male Female Smoking associations (Males 30 yrs only) (a) Percent (b) Total burden (in millions) 69% % % 6.7 Jindal et al Indian J chest Dis Allied Sci 2

16 Indian J Chest Dis Allied Sci 2006;4

17

18 Results Men women total Overall 5.0% 3.2% 4.1% S E status Low 6.6% 4.1% 5.4% Medium 4.3% 2.7% 3.5% High 3.6% 3.0% 3.3% Residence Rural 5.6% 3.2% 4.4% Urban 4.3% 3.1% 3.7% Mixed 9.3% 4.1% 6.5%

19 Results Smoking habits Men Women Total Non smoker 2.8% 3.1% 2.9% Ever smoker 7.8% 6.2% 7.7% Cigarette smoker 6.0% 4.1% 5.9% Bidi smoker 8.3% 6.2% 8.2% Hooka smoker 11.2% 6.6% 9.5%

20 COPD diagnosed in 4.1% of subjects Male to female ratio 1.56:1 Prevalence bidi smokers - 8.2% cigarette smokers 5.9% Odds ratio higher for men, elderly, lower socio economic status and urban or mixed residence

21 Estimated number of patients with COPD by severity of the disease ( millions) Severity of COPD Year Mild Moderate Severe Total Murthy et al NCMH Back ground pap

22 Estimated number of patients with chronic COPD (in Lakh) Males Females Total Year Urban Rural Urban Rural Urban Rural Murthy et al NCMH Back ground pape

23 Estimated number of patients with acute COPD (in lakh) Males Female Total no. of acute s cases Year Urban Rural Urban Rural Urban Rural Total Murthy et al NCMH Back ground pap

24 Treatment cost of a patient with COPD per year (in Rs.) current level Year Chronic case Hospitalization cost (acute case) Total cost ,331 2,390 12, ,436 4,167 22, ,541 6,144 32, ,646 8,018 42, ,751 9,894 52, ,856 11,774 62,630 Murthy et al NCMH Back ground pap

25 Total cost of treatment for COPD (Rs. In crore) current level Year Urban Rural Total , , , , , , , , , , , , , ,306.1 Murthy et al NCMH Back ground paper

26 Total cost of treatment of a patient with COPD (Rs. in crores) Year Guidelines Current cost , , , , ,306.1 Murthy et al NCMH Back ground pap

27 Work loss and COPD No longer a disease of only the elderly Loss of productivity and wages occurs Related to severity Mild 3.4% decrease in labor force Moderate 3.9% decrease in labor force Severe 14.4% decrease in labor force In US in $9.9 billion work loss National Medical expenditure survey- 3.6 work day loss/ year

28 COPD Fewer years in their life and less life in their years

29 Conclusions COPD is a major health problem in India and it will continue to increase in magnitude It prevalence is underestimated as uniform diagnostic standards not used National epidemiological data is lacking The economic cost of treatment is high It is associated with a significant work loss A disease surveillance program is needed

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