The prevalence, burden and risk factors associated with chronic obstructive pulmonary disease in Commonwealth of Independent States (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study

Abstract

BackgroundIn the Commonwealth of Independent States (CIS) countries the epidemiology of chronic obstructive pulmonary disease (COPD) is poorly characterized. The objective of this analysis is to present the prevalence, burden and risk factors associated with COPD in three CIS countries as part of the CORE study (Chronic Obstructive Respiratory Diseases), the rationale and design of which have been described elsewhere.MethodsA total of 2842 adults (≥18 years) were recruited (964 in Ukraine, Kiev, 945 in Kazakhstan, Almaty and 933 in Azerbaijan, Baku) between 2013 and 2015 during household visits. Two-step cluster randomization was used for the sampling strategy. All respondents were interviewed about respiratory symptoms, smoking status and medical history, and underwent spirometry with bronchodilator. COPD was defined as (i) “previously diagnosed” when the respondent reported that he/she had previously been diagnosed with COPD by a doctor, (ii) “diagnosed by spirometry” using the GOLD criteria (2011) based on spirometry conducted during the study (FEV1/FVC < 0.70), and (iii) “firstly diagnosed by spirometry”, when the patient had received the COPD diagnosis for the first time based on the spirometry results obtained in this study.ResultsThe prevalence of “previously diagnosed” COPD was 10.4, 13.8 and 4.3 per 1000, and the prevalence of COPD “diagnosed by spirometry” was 31.9, 66.7 and 37.5 per 1000 in Ukraine, Kazakhstan, and Azerbaijan, respectively. Almost all respondents with COPD were diagnosed for the first time during this study. A statistically significant relationship was shown between smoking and COPD in Kazakhstan (odds ratio, OR: 3.75) and Azerbaijan (OR: 2.80); BMI in Ukraine (OR: 2.10); tuberculosis in Ukraine (OR: 32.3); and dusty work in Kazakhstan (OR: 2.30). Co-morbidities like cardiovascular diseases and a history of pneumonia occurred significantly (p < 0.05) more frequently in the COPD population compared to the non-COPD population across all participating countries. For hypertension, this was the case in Ukraine and Azerbaijan.ConclusionIn CIS countries (Ukraine, Kazakhstan and Azerbaijan), the prevalence of COPD “diagnosed by spirometry” was significantly higher than the prevalence of previously diagnosed COPD. Compared to many other countries, the prevalence of COPD seems to be relatively low in CIS countries. Factors such as limited funding from the government; lack of COPD knowledge and the attitude within the population, and of primary care physicians; as well as low access to high-quality spirometry may play a role in this under-diagnosis of COPD. The information provided in this paper will be helpful for healthcare policy makers in CIS countries to instruct COPD management and prevention strategies and to allocate healthcare resources accordingly.

<p>Lifetime Occupational History, Respiratory Symptoms and Chronic Obstructive Pulmonary Disease: Results from a Population-Based Study</p>

“…In this regard, our findings are more consistent with studies in other countries than another Kazakhstan study using self-reported estimates (OR 2.3). 6 Interestingly, almost similar magnitude of effect was found in specific populations, like miners, when highly exposed workers are compared to those with low exposure, 7 or tractor plant workers. 23 In our multiple regression model, the strength of effect associated with occupational exposure may be as high as the one of smoking, and this will dictate Abbreviations: VGDF, vapors, gases, dusts and fumes; SHS, secondhand smoke; COPD, chronic obstructive pulmonary disease; OR, odds ratio; CI, confidence interval.…”

“…COPD prevalence in our analysis in the age group 40 and older equaled 5.6%, more in men (8.7% vs 3.4%), which was obviously different compared to another population-based study in Kazakhstan. 6 As opposed to the first study, which was guided by postbronchodilator FEV1/FVC<0.70, we only considered COPD in those with postbronchodilator FEV1/ FVC<LLN. Despite very wide use of FEV1/FVC<0.70 as COPD criterion, also recommended by GOLD, 13 fixed ratio is known to overestimate COPD, [14][15][16] especially in the elderly, 16 as it does not account for age-related natural FEV1/FVC drop, and false-positive COPD is frequent.…”

“…The lack of high-quality studies in developing nations coupled with high smoking prevalence and poor workplace surveillance programs may leave most patients unattended, when some action can still be taken to prevent the disease or slow its progression. Thus, there exists only one epidemiological study on COPD from the region of Central Asia, 6 showing 2-fold greater likelihood of COPD in those exposed to dust in the workplace, but no detailed stratification of occupations analyzed is provided. Moreover, with the evolving chemical technology in recent decades, novel exposures need more attention, and a lifelong occupational history would help to better understand the true association of such hazards with COPD.…”

Коморбідність Хронічного Обструктивного Захворювання Легень З Артеріальною Гіпертензією: Стан Системи Антиоксидантного Захисту

“…У Греції поширеність ХОЗЛ, за різними даними, коливається в межах від 9,6 до 17,1 % [13]. Дослідження CORE (Chronic Obstructive REspiratory diseases in CIS countries) показало, що поширення ХОЗЛ становило 10,4; 13,8 та 4,3 на 1000 населення відповідно в Україні, Казахстані та Азербайджані [14].…”

The role of insertion-deletion polymorphism of the ACE gene in development of arterial hypertension in patients with chronic obstructive pulmonary disease

“…Despite high mortality rates, very limited epidemiological COPD data are available in Ukraine. The CORE study conducted across major cities in Ukraine, Kazakhstan and Azerbaijan from the first half of 2013 until the end of 2015 have showed that prevalence of COPD diagnosed by spirometry (based on the Global Initiative for Chronic Obstructive Lung Disease guideline (2011) (FEV1/FVC < 0.70)) was 31.9 (95% CI 21.7-45.3) per 1000 of population in Ukraine 15 . Remarkably, almost all (90%) of the deaths caused by COPD occurred in low and middle-income countries (LMICs) 16 .…”