Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade
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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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Associated Pathologies

Picture 1

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Triggering Factors

3

1

Smoke

Air Pollution

2

Picture 2

Genetics

3

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Symptoms

Limitation of the flow of air to and from the lungs

1

Hemoptysis

2

3

Hyperinflation

4

Sputum

5

Dyspnea

Picture 3


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Symptoms

Limitation of the flow of air to and from the lungs

1

Hemoptysis

2

3

Hyperinflation

4

Sputum

5

Dyspnea

Picture 4


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Symptoms

Limitation of the flow of air to and from the lungs

1

Hemoptysis

2

3

Hyperinflation

4

Sputum

5

Dyspnea

7


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Symptoms

Limitation of the flow of air to and from the lungs

1

Hemoptysis

2

3

Hyperinflation

4

Sputum

5

Dyspnea

8


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD|

Ideal steps in clinical practice

Early Diagnosis.

Treatment

Picture 8

Favorable Prognosis

9


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD|

Treatments

Quit smoking

1

Oxygen therapy

2

Pharmaceutical treatment

3

4

Surgery

Picture 6

10


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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.


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Diseases of the Respiratory System (490-496)

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AN ALLIED CONDITIONS

19

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

OPERATIONS ON THE RESPIRATORY SYSTEM (32-33)

20

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Methods

Study classification

  • analytical

  • observational

Study Classification

Research

Statistical Analysis

23


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Methods

Statistical Analysis

  • IBM SPSS Statistics 20

    Hypothesis Tests

Study Classification

Research

Statistical Analysis

[11] National Institute of Statistics.

27


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

 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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

 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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

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


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

North

Number of admissions: 16 150

Number of citizens:3 737 791

0.43%

Center

Number of admissions:10 870

Number of citizens:2 382 448

0.46%

Lisbon

Number of admissions:12 791

Number of citizens:2 779 097

0.46%

Alentejo

Number of admissions:2 620

Number of citizens:765 971

0.34%

Algarve

Number of admissions:1 188

Number of citizens:416 847

0.28%

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

51


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

North

Number of admissions:16 929

Number of citizens:3 744 341

0.45%

Center

Number of admissions:10 506

Number of citizens:2 385 891

0.44%

Lisbon

Number of admissions:12 247

Number of citizens:2 794 226

0.44%

Alentejo

Number of admissions:2 601

Number of citizens:764 285

0.34%

Algarve

Number of admissions:1 157

Number of citizens:421 528

0.27%

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

52


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

North

Number of admissions:18 333

Number of citizens:3 745 236

0.49%

Center

Number of admissions:11 130

Number of citizens:2 385 911

0.47%

Lisbon

Number of admissions:12 949

Number of citizens:2 808 414

0.46%

Alentejo

Number of admissions:2 695

Number of citizens:760 933

0.35%

Algarve

Number of admissions:1 253

Number of citizens:426 386

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

53


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

North

Number of admissions:18 472

Number of citizens:3 745 439

0.49%

Center

Number of admissions:11 109

Number of citizens:2 383 284

0.47%

Lisbon

Number of admissions:12 522

Number of citizens:2 819 433

0.44%

Alentejo

Number of admissions:2 788

Number of citizens:757 069

0.37%

Algarve

Number of admissions:1 107

Number of citizens:430 084

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

54


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

 Statistical Analysis

COPD |

Results

Gender

Age

RESIDENCY

Length of stay

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

55


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Length of Stay

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

Total number of admissions:

377 076

56


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Med of length of stay (days)

cc

Year of admission

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

Total number of admissions:

377 076

57


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

 Statistical Analysis

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Med of length of stay (days)

cc

Kruskal-Wallis non-parametric test

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

Year of admission

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

Total number of admissions:

377 076

58


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Meanoflengthofstay (days)

cc

Children Young Adult Adult Elderly

Groupof age

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

Group ages:

Children: 0-17

Young adults: 18-29

Adults: 30-64

Elderly: ≥65

Total number of admissions:

377 076

59


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

 Statistical Analysis

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Meanoflengthofstay (days)

Kruskal-Wallis non-parametric test

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

Children Young Adult Adult Elderly

Groupof age

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

Group ages:

Children: 0-17

Young adults: 18-29

Adults: 30-64

Elderly: ≥65

Total number of admissions:

377 076

60


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Medoflengthofstay (days)

Men Women

Gender

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

Total number of admissions:

377 076

61


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

 Statistical Analysis

COPD |

Results

Gender

Age

Residency

LENGTH OF STAY

Surgicalprocedures

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Meanoflengthofstay (days)

Mann-Whitney non-parametric test

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

Men Women

Gender

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

Total number of admissions:

377 076

62


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

13 617

Results

Gender

Age

Residency

Length of stay

SURGICAL PROCEDURES

Admission by year and seasonal variations

Influence of 2007 smoke-free law

1 201

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

Total number of admissions:

377 076

63


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

Number of surgical procedures on the respiratory system:

14 818

COPD |

Results

Gender

Age

Residency

Length of stay

SURGICAL PROCEDURES

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Total number of admissions:

377 076

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)

64


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

Number of surgical procedures on the respiratory system:

14 818

COPD |

Results

Gender

Age

Residency

Length of stay

SURGICAL PROCEDURES

Admission by year and seasonal variations

Influence of 2007 smoke-free law

Total number of admissions:

377 076

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)

65


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

Results

Gender

Age

Residency

Length of stay

Surgicalprocedures

ADMISSION BY YEAR AND SEASONAL VARIATIONS

Influence of 2007 smoke-free law

Total number of admissions (secondary diagnosis):

268 685

Total number of admissions (principal diagnosis):

116 690

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)

66


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

COPD |

2000

2001

2002

2003

2004

2005

2006

2007

2008

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

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).

67


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

This law was only implemented in 2007, and our data only goes from 1990 to 2008

Evaluating the consequences of this law will only be possible when time has been given for it to have effect.

We do not have enough data to form any solid conclusions regarding this parameter.

COPD |

Results

Gender

Age

Residency

Length of stay

Surgical procedures

Admission by year and seasonal variations

INFLUENCE OF2007SMOKE-FREE LAW

68


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

  • References

  • World Wide Web

  • 1.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 - Medline

  • 4.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 Portugal

  • 5. www.paraquenaolhefalteoar.com/slpage_info.php?id=2

  • 6. http://www.drpereira.com.br/dpoc.htm

  • 7.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

Ana Luís Pimenta de Almeida Ferreira

Ana Raquel Torres Pinto

Ângelo Emanuel Martins Rodrigues Neves

Diogo Alexandre Santos Ferreira

Eduarda Maria de Oliveira Duarte

Filipa Lima Carneiro Marques dos Santos

Inês Azevedo da Costa Maia

Inês Maria Rocha Carneiro

João Pedro Marcos Calvão

João Pedro Rosa de Oliveira

Mafalda da Costa Aguiar Mourisco

Marta Isabel Maia de Andrade Moreira

69


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

  • 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.

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

Available:http://www.who.int/respiratory/copd/burden/en/index.html.

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

Ana Luís Pimenta de Almeida Ferreira

Ana Raquel Torres Pinto

Ângelo Emanuel Martins Rodrigues Neves

Diogo Alexandre Santos Ferreira

Eduarda Maria de Oliveira Duarte

Filipa Lima Carneiro Marques dos Santos

Inês Azevedo da Costa Maia

Inês Maria Rocha Carneiro

João Pedro Marcos Calvão

João Pedro Rosa de Oliveira

Mafalda da Costa Aguiar Mourisco

Marta Isabel Maia de Andrade Moreira

70


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

  • References

  • Publications

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

[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.

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

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

[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.

Ana Luís Pimenta de Almeida Ferreira

Ana Raquel Torres Pinto

Ângelo Emanuel Martins Rodrigues Neves

Diogo Alexandre Santos Ferreira

Eduarda Maria de Oliveira Duarte

Filipa Lima Carneiro Marques dos Santos

Inês Azevedo da Costa Maia

Inês Maria Rocha Carneiro

João Pedro Marcos Calvão

João Pedro Rosa de Oliveira

Mafalda da Costa Aguiar Mourisco

Marta Isabel Maia de Andrade Moreira

71


Have c hronic o bstructive p ulmonary d isease admissions increased over the last decade

  • References

  • Publications

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

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

Available:http://www.who.int/respiratory/copd/burden/en/index.html.

[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

Ana Luís Pimenta de Almeida Ferreira

Ana Raquel Torres Pinto

Ângelo Emanuel Martins Rodrigues Neves

Diogo Alexandre Santos Ferreira

Eduarda Maria de Oliveira Duarte

Filipa Lima Carneiro Marques dos Santos

Inês Azevedo da Costa Maia

Inês Maria Rocha Carneiro

João Pedro Marcos Calvão

João Pedro Rosa de Oliveira

Mafalda da Costa Aguiar Mourisco

Marta Isabel Maia de Andrade Moreira

72


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