Associated factors to COPD in Romania
Prof. Dr. Florin Dumitru
1"Marius
1
Mihălţan ,
Dr. Florentina
2
Furtunescu ,
Dr. Roxana Maria
1
Nemeş ,
Dr. Dana
3
Fărcăşanu ,
Dr. Ioana Mirela
3
Dărămuş
, Romania
Nasta", National Institute of Pulmonology, Romanian Society of Pulmonology, 2 Public Health Department, "Carol Davila" University of Medicine and Pharmacy, 3 Center for Health Policies and Services, Bucharest
Results
Introduction
COPD is a very important public health problem, from individuals perspective (by affecting their productivity, quality
of life and life expectancy), but also from the health system’s perspective (by inducing serious costs for the
ambulatory or in-hospital treatment of these patients) (1).
The prevalence of COPD in Romania is not known. However, in 2010, 103,943 admissions were registered in
Romania having COPD as the first diagnosis, meaning 2.05% from the total admissions at national level. (2) 64.7%
from the cases were severe (2). They were responsible of almost 1 million hospitalization days (2). Cases with comorbidities, having COPD as the second or the third diagnosis at admissions were not considered. This is a huge
burden for the hospitals sector. To these we suppose to add the ambulatory visits and the drugs used for COPD
treatments for having a complete image about the medical costs, but these figures are not known.
Sample description:
Figure 1. Structure by education
•Gender structure: 49.6% males and 50.4% females
•Age distribution: mean age 58.311.27 years, no difference among genders.
55.2% of subjects were bellow the age of 60.
,3
11,4
27,7
1 to 8
9 t0 12
Faculty
not known
•Urban versus rural: 61.7% in urban and 38.3% in rural
•Education (fig. 2)
•Occupation: 67.9% of the subjects were retired. Only 30% were employed and
1.3% unemployed.
60,6
Knowing the prevalence of COPD is extremely useful in health services planning, but using an early detection tool is
crucial for life duration and quality of life of the patient.
•Income Category: 8.3%, 33.9%, 29.1%, 11.8% of subjects had no income, very
low, low or medium/high income respectively (16.9% didn’t declare their income)
Our study aimed to estimate the prevalence of COPD in Romanians aged 40+ in relations to social variables and
different household exposures.
This is the first epidemiological survey for COPD prevalence done in Romania using both questionnaires and
spirometric investigation
COPD prevalence: 9.7% of the responders were found with COPD (15.7% from males and 3.9% from females
respectively (p<0.001)
Table 1: COPD prevalence upon social variables
Fig.1. The study algorithm
Methods
A cross-sectional survey was performed in the general
population aged 40+, in Romania. We used a two-stadial
stratification probabilistic model, from a sample of 15000
households. 9638 subjects were selected, with a confidence
interval of 1%.
A pre-screening was used to identify the subjects at risk for
COPD, due to smoking, cough, or stifle (3)
51% of the responders were identified as being at risk for
COPD from the general population aged 40+ (N=4930).
A sub-sample of 2000 subjects were invited to perform a
spirometric evaluation (at least 3 spirometry tests per patient,
according to ATS/ERS standards).
The response rate was of 82.3% and 217 patients were
excluded for incomplete or invalid results in spirometry.
Positive diagnosis: the patients that smoked (current or
former smokers) and had a FEV1 ratio lower than 0.7 were
considered as having COPD.
Variable
Gender
Age-category
Geography
Education
Economic
activity
Income
Cathegories
Males
Females
15.7%
3.9%
Bellow 60
60+
8.0%
11.9%
Urban
Rural
9.9%
9.5%
Low/medium
High
10.1%
6.1%
Employed
Retired
11.9%
8.7%
OR
CI limits
4.631
3.016: 7.109
0.644 0.4531: 0.9153
1.042
1.727
1.425
Table 2: COPD prevalence
upon household exposures
Energy type
Wood/coal
Heating
Cooking
10.0%
11.3%
Gas
9.8%
9.3%
Electric energy
8.9%
0.0%
Other
9.9%
0.0%
p-value
0.987
0.282*
0.726: 1.495
0.888: 3.359
0.9859: 2.059
Very low/low Medium/high
9.1%
11.2%
0.793
0.4701: 1.337
* Chi square test wood/coal versus gas
The social variables: we considered rural/urban area,
education (no. of school years), occupation, income category.
Conclusions
Household exposures were type of heating for cooking and
source of household heating
Acknowledgement
This project was granted by the Center for Health Policies and Services in the frame of Phase2 - Operational
Research Program, financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.
We would like to thank to:
•The Center for Health Policies and Services – for financing and supporting the project
•The Romanian Angel Appeal Foundation – for supervising the Global Fund projects in Romania
•The Global Fund – for financing TB interventions in Romania
Corresponding author - Prof. Dr Florin Dumitru Mihaltan, mihaltan@starnets.ro
Around half of the Romanian population aged 40+ meets the criteria for being at risk for COPD. This means
around 5 million people at risk, from which 9.7% will have a positive diagnosis (around 475000 cases). Age
above 60 and masculine gender had a higher probability to be associated to COPD. The other social
variables (geographic area, education, occupation and income) but also the household exposure such
heating and cooking energy type) seemed not to be associated to COPD.
Bibliography
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