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Vulnerability of Patients with Chronic Obstructive Pulmonary Disease According to Gender in China

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Vulnerability of Patients with Chronic Obstructive Pulmonary Disease According to Gender in China International Journal of COPD Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Vulnerability of patients with chronic obstructive pulmonary disease according to gender in China Peian Lou1 Background: Little information is available regarding the vulnerability of patients with Yanan Zhu2 chronic obstructive pulmonary disease (COPD) in China. We aimed to assess this according Peipei Chen1 to patient gender. Pan Zhang1 Methods: A cross-sectional study was conducted in the rural area of Xuzhou in China. We Jiaxi Yu1 interviewed and administered questionnaires to 2825 male and 2825 female patients with COPD Ning Zhang1 and subjected the data generated to statistical analysis. We compared differences between proportions of male and female patients using the 2 test. Lei Zhang1 χ Results: The rate of current smoking in men was 30.1%, whereas that in women was 10.9%, Hongmin Wu2 and 31.5% of men had a history of using biomass fuel compared with 75.3% of women. Further, Jing Zhao2 For personal use only. 26.0% of the male patients and 16.4% of the female patients did not take theophylline regularly 1 Na Chen when their disease was stable. During acute exacerbations, 65.8% of the male patients and 39.7% 1Xuzhou Center for Disease Control of the female patients took theophylline or similar drugs. The average potential shortening of life 2 and Prevention, Department of expectancy was 1.76 years for men and 1.18 years for women. The average indirect economic Respiratory Medicine, Affiliated Hospital of Xuzhou Medical College, burden was 11158.4 yuan for men and 7481.2 yuan for women. The quality of life was worse Xuzhou City, Jiangsu Province, in female patients than in male patients. Xuzhou, China Conclusion: We found that patients with COPD were vulnerable and that factors determin- ing vulnerability were different for men than for women. Therefore, we recommend adopting different measures for men and women when attempting to prevent, control, and treat COPD, rehabilitate these patients, and improve their quality of life. Keywords: chronic obstructive pulmonary disease, gender, vulnerability Introduction Chronic obstructive pulmonary disease (COPD) is a progressive disease defined by a limitation of airflow that is at least partially irreversible.1 It is a 1eading cause of International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 54.191.40.80 on 17-Jun-2017 increased morbidity and mortality, being estimated to rank seventh worldwide as a disease burden and third as a cause of death.2–4 In China, COPD affects 8% of people aged 40 years or older.5 Every year, there are over 40 million patients with COPD in China and its annual death toll is over 1.28 million. COPD disables about 5–10 million of these people, preventing them from working and earning a living.6 In addition to Correspondence: Peian Lou seriously impacting ability to work and quality of life, patients with COPD use a lot Xuzhou Center for Disease Control of medical resources and impose a heavy economic burden on society. In China, the and Prevention, 142 West Erhuan Road, annual direct medical costs per capita for patients with COPD are as high as 11,744 yuan, Xuzhou City, Jiangsu Province, Xuzhou 221006, China and indirect medical expenses (including transportation, buying health care products, Tel +86 516 8595 6785 nursing costs) cost about 1570 yuan.7 However, so far, the Chinese government has no Fax +86 516 8595 6785 Email [email protected] countrywide program for preventing COPD and treating patients with the disease. submit your manuscript | www.dovepress.com International Journal of COPD 2012:7 825–832 825 Dovepress © 2012 Lou et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article http://dx.doi.org/10.2147/COPD.S37447 which permits unrestricted noncommercial use, provided the original work is properly cited. Powered by TCPDF (www.tcpdf.org) 1 / 1 Lou et al Dovepress Prevention and treatment of patients with COPD depends prevention, treatment, and rehabilitation, and reviewed some on the ability of patients to recognize the condition. The relevant domestic and foreign published papers.12–14 We then vulnerability of a population is reflected by the possibility designed the questionnaire and determined that it had high and extent of population health losses caused by various fac- reliability (0.88) and validity (0.86). It consists of 100 items tors or changes in the health system. The vulnerability of a and has five subscales: namely, demographic data (10 items), population also reflects its sensitivity to risks,8 and is mainly patient knowledge about COPD (15 items), behaviors (five determined by people’s resistance or susceptibility to disease, items), disease management (10 items), quality of life assess- and high vulnerability is associated with prolonged recovery.9 ment using the Saint George’s Respiratory Questionnaire The vulnerability of COPD patients is determined by their (SGRQ),12 and economic burden (10 items). The SGRQ is a knowledge about COPD, high-risk behavior, management of standardized, self-administered, pulmonary-specific health their COPD, burden of disease, and many other factors that status questionnaire containing 50 items and 76 weighted are influenced by the patient’s behavior, social environment, responses with three subscales, namely symptoms (eight and medical history. items), activity (16 items), and impacts (26 items). The total To evaluate the vulnerability of people, things, or events, score varies from 0 to 100, with higher scores indicating we must first identify the factors that lead to vulnerability. worse health status. Once these have been identified, we can make interventions aimed at reducing susceptibility and increasing resilience. Measurement of exposure to relevant Therefore, study of the degree of vulnerability of patients factors and confounders with COPD can provide a scientific basis for developing We interviewed the 5900 patients with COPD face to face targeted control measures. In China, factors causing COPD in their homes. We recorded responses to the items about in men and women are significantly different.10 Vulnerability age, gender, current employment status, level of education, may also differ between male and female patients, and there cigarette smoking status, marital status, physical activity, is still a lack of research in this area in China. In the present family history of COPD, and other factors using the ques- For personal use only. study, we investigated the vulnerability of male and female tionnaire we had designed. We ascertained and recorded patients to COPD, with the aim of providing a scientific inpatient costs (including the cost of patient transportation basis for interventions to prevent and treat COPD in large and meals, costs incurred by their escorts, and wages paid to community-based settings in China and other countries. caregivers), outpatient costs (including those for outpatient accommodation), in-home treatment costs, costs of long-term Materials and methods medication regimens (including prescribed drugs purchased Study population at the patient’s own expense and self-medication drugs), and We selected 8217 patients with COPD randomly from costs related to lost productivity and lost employment during 14 towns in the Xuzhou area. COPD was diagnosed by the previous year by examining patients’ hospital records and the standards outlined in the Global Initiative for Chronic their logs in township and village clinics. We ascertained the Obstructive Lung Disease (GOLD).1 How we selected the patients’ per capita incomes and life expectancies from data patients for this research has been described elsewhere.11 in the Xuzhou Statistical Yearbook and Resident Annual In the present study, we matched patients enrolled with Deaths Report of 2008. COPD by age (± one year), number of family members We calculated direct economic burdens based on data International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 54.191.40.80 on 17-Jun-2017 (± one member), education level, stage according to GOLD from our questionnaire. We estimated indirect economic criteria, and duration of disease. To eliminate factors that burdens using data about local per capita income and life would seriously affect COPD-related data, we excluded expectancy from 2008. To estimate the risk of premature patients with severe heart, liver, kidney, and lung diseases death, we assessed the years of potential life lost (YPLL) as and those with nervous or mental disorders. We also excluded a result of COPD per 100,000 people. According to local life patients with insufficient data available. Finally, we included expectancy statistics, the average age at death is 70 years. 5900 cases in the study (Figure 1). Therefore, the YPLL is the difference between 70 years and the patient’s age at time of death. Using the 2000 census Questionnaire design report, we ascertained the age composition of China’s popula- In preparation for designing the vulnerability questionnaire, tion and used this to adjust the composition of the population we consulted with COPD experts concerning epidemiology, of Xuzhou city in 2008. We calculated the YPLL according 826 submit your manuscript | www.dovepress.com International Journal of COPD 2012:7 Dovepress Powered by TCPDF (www.tcpdf.org) 1 / 1 Dovepress Gender-related vulnerability to COPD 24,641 patients of 1.14 million inhabitants in 28 towns Randomly selected 12,875 patients of 0.6 million inhabitants in 14 towns Exclusion criteria: severe heart, liver, kidney, nervous or mental disorders, other diseases (n = 3937) Total patients screened (n = 8938) Died (n = 201) Declined to take part or left the town (n = 435) Total respondents (n = 8302) Respondents who then completed only the partial survey (n = 85) For personal use only. Respondents who were eligible for Respondents who did not complete the the survey (n = 8217) economic survey (n = 834) Matched by age (± one year), family total population (± one person), education level, stage of GOLD, and years of disease.
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