英文ppt课件chronicobstructive pulmonary disease （copd）

Table of Contents,Slides,Sources,Breezing AM, Watson DE, Black C. Chronic conditions and co-morbidity among residents of British Columbia. Vancouver: Centre for Health Services and Policy Research; 2005. Johns Hopkins Bloomberg School of Public Health. The Johns Hopkins Adjusted Clinical Groups (ACG) Case-Mix System Reference Manual. Version 7.0. Baltimore: The Johns Hopkins University; 2005. Johns Hopkins Bloomberg School of Public Health. The Johns Hopkins Adjusted Clinical Groups (ACG) Case-Mix System Technical User Guide. Version 7.0. Baltimore: The Johns Hopkins University; 2005.,Background:,Chronic diseases affect a significant number of Canadians; account for a large proportion of health care service utilization and associated direct and indirect health care costs; are more common with increasing age and lower socioeconomic status; are often associated with modifiable risk factors such as tobacco use, unhealthy diet and lack of physical activity; are subject to delayed onset; and are often considered to be preventable. Centre for Health Services and Policy Research (CHSPR) at the University of British Columbia identified eleven “high-impact and/or high-prevalence” chronic conditions. Combinationprevalence and impacthas important implications for the planning and allocation of health care resources.,Background (contd):,Used the Expanded Diagnosis Clusters (EDCs) Johns Hopkins ACG Case-Mix System (version 7.0) tool Estimated “treated” prevalence in Ontario for 2006/07 for 5 of the 11 high-impact and/or high-prevalence chronic diseases, including: Degenerative joint disease (osteoarthritis) Ischemic heart disease (IHD) Cardiac arrhythmia Chronic obstructive pulmonary disease (COPD) Cerebrovascular disease Prevalence rates for other chronic conditions (diabetes, asthma, cancer, congestive heart failure and hypertension) not reported using the ACG System already being measured, or will be measured in the near future, using validated algorithms developed by ICES and Cancer Care Ontario.,Methodology:,Fiscal year 2006/07 Cohort = Ontarians (derived from the Registered Persons Database RPDB) EDC algorithm applied to Canadian Institute for Health Informations Discharge Abstract Database (CIHI-DAD) and Ontario Health Insurance Plan (OHIP) records over a two-year period (April 1, 2005 to March 31, 2007) Algorithm mapped CIHI-DAD and OHIP to the following EDCs: Degenerative joint disease: MUS03 Ischemic heart disease (excluding acute myocardial infarction): CAR03 Cardiac arrhythmia: CAR09 Emphysema, chronic bronchitis, COPD: RES04 Cerebrovascular disease: NUR05,Exclusions: Persons less than 20 years of age (less than 35 years of age for calculation of COPD rates) Out-of-province residents Records with missing/invalid age, sex, and/or LHIN information Individuals who died or whose date of last contact with the health care system was greater than 5 years Population estimates (as of April 1, 2006) were calculated using the RPDB. Age- and sex-adjusted prevalence rates were standardized using Ontarios 2001 census population. Neighbourhood median household income ranked by quintiles (obtained from Statistics Canada census data) used as estimate of socioeconomic status (SES),Methodology (contd):,Osteoarthritis (degenerative joint disease),Most common form of arthritis Causes breakdown of cartilage (covers and protects the ends of bones in joints) Commonly affects joints in the hands, feet and spine and large weight-bearing joints (hips and knees) causing pain, swelling, stiffness, reduced range of joint motion, disability in everyday living activities and mobility Greater risk for individuals that are older, overweight, have a family history of osteoarthritis and/or previous joint injury No cure; treatments (e.g., medication, exercise, physiotherapy, weight loss) can increase joint mobility and decrease pain and disability. In severe cases, surgery may be performed to replace the entire joint, especially the hip or knee.,Key Findings: Osteoarthritis,Overall prevalence rates (2006/07) In 2006/07, little variation in prevalence rates among LHINs Twelve out of 14 LHIN prevalence rates were within 10% of the Ontario rate (9.3 per 100 persons). Highest (11.3 per 100 persons) and lowest (7.6 per 100 persons) rates were observed in the Erie St. Clair and Waterloo Wellington LHINs, respectively.,Age- and sex-adjusted prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, 2006/07,By Local Health Integration Network (LHIN) in Ontario,Age- and sex-adjusted prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Osteoarthritis,Prevalence rates by sex and/or age group (2006/07) Rates for men and women in Ontario increased with age, leveling off after 74 years of age. For women, those aged 7584 had highest prevalence rates; for men, rates were highest in the 85+ age group. For both men and women, 5064 age group had highest volume (number of cases). Across all age groups, prevalence rates consistently higher in women than in men at the Ontario level and in most of the LHINs. Disparity was greatest in the 5064 age group where the rates for women were 51% higher than those for men.,Prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by sex and age group, 2006/07,Prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by sex and age group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Age-adjusted prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by sex and sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Osteoarthritis,Prevalence rates by neighbourhood income quintile (2006/07) At the provincial level, prevalence rates increased as neighbourhood income level decreased. Among the LHINs, prevalence rates in the middle income quintiles (Q2Q4) often had overlapping confidence intervals; however, in every LHIN (except the North West LHIN), prevalence rates in the lowest income quintile (Q1) were significantly higher than those in the highest income quintile (Q5).,Age- and sex-adjusted prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by neighbourhood income quintile*, 2006/07,Age- and sex-adjusted prevalence rate of osteoarthritis per 100 Ontarians aged 20 years and older, by neighbourhood income quintile*, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Ischemic heart disease (IHD),Heart problems caused by the narrowing of heart arteries, leading to a reduction in blood flow and oxygen to the heart muscle; term often used interchangeably with “coronary artery disease” and “coronary heart disease”. Risk increases with age, smoking, high cholesterol levels, high blood pressure, obesity, diabetes and family history of certain heart conditions. IHD can be present without symptoms (silent ischemia), but more often causes chest pain (angina pectoris). stable (i.e., occurs under predictable circumstances, such as physical exertion or stress, and subsides with medication or rest) unstable (i.e., sudden onset becoming increasingly worse; can be a warning sign of heart attack) Individuals with IHD may have had previous heart attack (old myocardial infarction). Treatment involves use of medication, surgery and lifestyle changes.,Key Findings: Ischemic heart disease (IHD),Overall prevalence rates (2006/07) In 2006/07, prevalence rates varied across LHINs Less than half of LHINs had overall prevalence rates within 10% of the Ontario rate (6.2 per 100 persons). Overall rate in the Central East LHIN (7.8 per 100 persons) was 66% higher than the overall rate in the Waterloo Wellington LHIN (4.7 per 100 persons).,Age- and sex-adjusted prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, 2006/07,By Local Health Integration Network (LHIN) in Ontario,Age- and sex-adjusted prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, by sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Ischemic heart disease (IHD),Prevalence rates by sex and/or age group (2006/07) Rates for men and women in Ontario increased with age. Rates increased two- to three-fold up to 75 years of age. Prevalence rates were highest in the oldest age group (85+ years) for both men and women. For women, the 7584 age group had the highest volume (number of cases); for men, volume was highest in the 5064 age group. At the provincial and LHIN levels, after 34 years of age, men had significantly higher rates than women. Disparity between men and women increased with age groups until 5064 years at which point the disparity was greatestrates for men were almost twice as high as those for women; from 65 years old and onward, the gap in rates between men and women narrowed through to age 85+ years.,Prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, by sex and age group, 2006/07,Prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, by sex and age group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Age-adjusted prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, by sex and sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Ischemic heart disease (IHD),Prevalence rates by neighbourhood income quintile (2006/07) At the provincial level, prevalence rates increased as neighbourhood income level decreased. Throughout all LHINs, prevalence rates in the lowest income quintile (Q1) were significantly higher than those in the highest income quintile (Q5).,Age- and sex-adjusted prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, by neighbourhood income quintile*, 2006/07,Age- and sex-adjusted prevalence rate of ischemic heart disease (IHD) per 100 Ontarians aged 20 years and older, by neighbourhood income quintile*, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Arrhythmia,An abnormal rhythm of the hearteither beating too quickly (tachycardia), too slowly (bradycardia), or irregularly. Caused by an abnormality in the generation or movement of electrical activity through the heart. Treatment ranges: lifestyle changes, drug therapy, implantation of a permanent pacemaker or an implantable cardioverter-defibrillator Some forms of arrhythmia life-threatening if not promptly and properly treated.,Key Findings: Arrhythmia,Overall prevalence rates (2006/07) In 2006/07, little variation in prevalence rates among LHINs Eleven out of 14 LHIN prevalence rates were within 10% of the Ontario rate (3.6 per 100 persons). Highest (4.2 per 100 persons) and lowest (3.1 per 100 persons) rates were observed in the Central and Waterloo Wellington LHINs, respectively.,Age- and sex-adjusted prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, 2006/07,By Local Health Integration Network (LHIN) in Ontario,Age- and sex-adjusted prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, by sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Arrhythmia,Prevalence rates by sex and/or age group (2006/07) Prevalence rates for men and women in Ontario increased with age, with rates doubling between age groups 3549, 5064, 6574 and 7584 years. For both men and women, prevalence rates were highest in the oldest age group (85+ years); 7584 age group had highest volume (number of cases). At the provincial level and for most LHINs, in the younger age groups (2034, 3549), prevalence rates of arrhythmia were slightly higher in women than in men. After age 49, however, rates of arrhythmia in men became higher than those in women. Greatest disparity in rates in the 6574 age group where men had rates that were 34% higher than those in women.,Prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, by sex and age group, 2006/07,Prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, by sex and age group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Age-adjusted prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, by sex and sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Arrhythmia,Prevalence rates by neighbourhood income quintile (2006/07) Prevalence rates of arrhythmia remained steady across neighbourhood income quintiles in Ontarioan unusual finding because low socioeconomic status (SES) has traditionally been considered a risk factor for cardiovascular disease in general. Recent study1 also noted unexpected relationship between atrial fibrillation (most common form of arrhythmia) and SES: prevalence of atrial fibrillation decreased with decreasing SES. Association might be related to better screening (more diagnoses) for those living in more affluent areas, and perhaps to poorer survival of those patients with atrial fibrillation who resided in less affluent neighbourhoods. 1Murphy NF, Simpson CR, Jhund PS, et al. A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland. Heart. 2007; 93(5):606612.,Age- and sex-adjusted prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, by neighbourhood income quintile*, 2006/07,Age- and sex-adjusted prevalence rate of arrhythmia per 100 Ontarians aged 20 years and older, by neighbourhood income quintile*, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Chronic Obstructive Pulmonary Disease (COPD),A slow-developing chronic lung disease characterized by airflow limitation due to airway damage, resulting in shortness of breath (dyspnea), wheezing, increased mucus production and coughing. COPD includes both chronic bronchitis and emphysema. Most COPD caused by cigarette smoking; other contributing causes are: heredity, second-hand smoke, prolonged exposure to airway irritants (dust, chemicals, pollution) and a history of lung infections during childhood. No cure; treatment is largely to treat and prevent symptoms and involves lifestyle changes, medication, pulmonary rehabilitation and, in some severe cases, surgery.,Key Findings: Chronic Obstructive Pulmonary Disease (COPD),Overall prevalence rates (2006/07) In 2006/07, prevalence rates varied among LHINs Only 4 out of 14 LHIN rates were within 10% of the Ontario rate (3.6 per 100 persons). Erie St. Clair and North East LHINs had the highest rates (5.2 per 100 persons), while the Central West, Mississauga Halton and Central LHINs had the lowest rates (2.6 per 100 persons).,Age- and sex-adjusted prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, 2006/07,By Local Health Integration Network (LHIN) in Ontario,Age- and sex-adjusted prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Chronic Obstructive Pulmonary Disease (COPD),Prevalence rates by sex and/or age group (2006/07) Prevalence rates for men and women in Ontario increased with age, with rates increasing two- to three-fold between 3574 years of age. For both men and women, prevalence rates were highest in the oldest age group (85+ years); 5064 age group had highest volume (number of cases). At the provincial level, after age 64, prevalence rates were markedly higher in men than in women; this disparity increased with age. At the LHIN level, prevalence rates tended to be similar in many LHINs between men and women up to age 64, after which rates consistently followed Ontario level trends (i.e., rates higher in men vs. women, disparity increasing with age).,Prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by sex and age group, 2006/07,Prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by sex and age group, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Age-adjusted prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by sex and sub-LHIN planning area, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Chronic Obstructive Pulmonary Disease (COPD),Prevalence rates by neighbourhood income quintile (2006/07) At the provincial level, prevalence rates of COPD increased as neighbourhood income level decreased; this association was also quite consistent at the LHIN level.,Age- and sex-adjusted prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by neighbourhood income quintile*, 2006/07,Age- and sex-adjusted prevalence rate of chronic obstructive pulmonary disease (COPD) per 100 Ontarians aged 35 years and older, by neighbourhood income quintile*, 2006/07 LHIN 1 (Erie St. Clair) vs. Ontario,Key Findings (contd) : Chronic Obstructive Pulmonary Disease (COPD),Interpretative caution for COPD1,2 COPD believed under-diagnosed in primary care, especially in younger age groups (less than 60 years old). Development of COPD is subtle yet gradually cumulative. Individual may satisfy respiratory function criteria for diagnosis (e.g., spirometry) before complaining of noticeable symptoms (e.g., wheezing). In a recent study, close to half the population of general practice patients at high risk for COPD had a diagnosis of COPD approximately two-thirds of them were newly diagnosed through a case-finding programme (i.e., spirometric testing) vs. through complaint of noticeable symptoms (e.g., wheezing). 1Upshur REG, Wang L, Luo J, Maaten S, Leong A. Primary care for respiratory diseases. In: Jaakkimainen L, Upshur R, Klein-Geltink JE, Leong A, Maaten S, Schultz SE, Wang L, editors. Primary Care in Ontario: IC