The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study

Evelyn A Brakema, Aizhamal Tabyshova, Rianne M J J van der Kleij, Talant Sooronbaev, Christos Lionis, Marilena Anastasaki, Pham Le An, Luan Than Nguyen, Bruce Kirenga, Simon Walusimbi, Maarten J Postma, Niels H Chavannes, Job F M van Boven, FRESH AIR collaborators, Pham Le An, Marilena Anastasaki, Azamat Akylbekov, Andy Barton, Antonios Bertsias, Pham Duong Uyen Binh, Job F M van Boven, Evelyn A Brakema, Dennis Burges, Lucy Cartwright, Vasiliki E Chatzea, Niels H Chavannes, Liza Cragg, Tran Ngoc Dang, Ilyas Dautov, Berik Emilov, Irene Ferarrio, Frederik A van Gemert, Ben Hedrick, Le Huynh Thi Cam Hong, Nick Hopkinson, Elvira Isaeva, Rupert Jones, Corina de Jong, Sanne van Kampen, Winceslaus Katagira, Bruce Kirenga, Jesper Kjærgaard, Rianne M J J van der Kleij, Janwillem Kocks, Le Thi Tuyet Lan, Tran Thanh Duv Linh, Christos Lionis, Kim Xuan Loan, Maamed Mademilov, Andy McEwen, Patrick Musinguzi, Rebecca Nantanda, Grace Ndeezi, Sophia Papadakis, Hilary Pinnock, Jillian Pooler, Charlotte C Poot, Maarten J Postma, Anja Poulsen, Pippa Powell, Nguyen Nhat Quynh, Susanne Reventlow, Dimitra Sifaki-Pistolla, Sally Singh, Talant Sooronbaev, Jaime Correia de Sousa, James Stout, Marianne Stubbe Østergaard, Aizhamal Tabyshova, Ioanna Tsiligianni, Tran Diep Tuan, James Tumwine, Le Thanh Van, Nguyen Nhu Vinh, Simon Walusimbi, Louise Warren, Sian Williams, Evelyn A Brakema, Aizhamal Tabyshova, Rianne M J J van der Kleij, Talant Sooronbaev, Christos Lionis, Marilena Anastasaki, Pham Le An, Luan Than Nguyen, Bruce Kirenga, Simon Walusimbi, Maarten J Postma, Niels H Chavannes, Job F M van Boven, FRESH AIR collaborators, Pham Le An, Marilena Anastasaki, Azamat Akylbekov, Andy Barton, Antonios Bertsias, Pham Duong Uyen Binh, Job F M van Boven, Evelyn A Brakema, Dennis Burges, Lucy Cartwright, Vasiliki E Chatzea, Niels H Chavannes, Liza Cragg, Tran Ngoc Dang, Ilyas Dautov, Berik Emilov, Irene Ferarrio, Frederik A van Gemert, Ben Hedrick, Le Huynh Thi Cam Hong, Nick Hopkinson, Elvira Isaeva, Rupert Jones, Corina de Jong, Sanne van Kampen, Winceslaus Katagira, Bruce Kirenga, Jesper Kjærgaard, Rianne M J J van der Kleij, Janwillem Kocks, Le Thi Tuyet Lan, Tran Thanh Duv Linh, Christos Lionis, Kim Xuan Loan, Maamed Mademilov, Andy McEwen, Patrick Musinguzi, Rebecca Nantanda, Grace Ndeezi, Sophia Papadakis, Hilary Pinnock, Jillian Pooler, Charlotte C Poot, Maarten J Postma, Anja Poulsen, Pippa Powell, Nguyen Nhat Quynh, Susanne Reventlow, Dimitra Sifaki-Pistolla, Sally Singh, Talant Sooronbaev, Jaime Correia de Sousa, James Stout, Marianne Stubbe Østergaard, Aizhamal Tabyshova, Ioanna Tsiligianni, Tran Diep Tuan, James Tumwine, Le Thanh Van, Nguyen Nhu Vinh, Simon Walusimbi, Louise Warren, Sian Williams

Abstract

Background: Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors.

Methods: We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed.

Results: Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8-51.7] and decreased productivity (presenteeism) of 20.0% [0.0-40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0-16.7]. The total population reported 40.0% [20.0-60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47-10.36), smoking (B = 5.97, 95%CI = 1.73-10.22), and solid fuel use (B = 3.94, 95%CI = 0.56-7.31) were potentially modifiable risk factors for impairment.

Conclusions: In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.

Keywords: Chronic lung disease; Chronic respiratory disease; Health economics; Household air pollution; Low-income population; Low-resource countries; Obstructive lung disease; WPAI; Work.

Conflict of interest statement

None to declare. Part of the results of this study have been previously reported in preliminary form as an abstract [51].

Figures

Fig. 1
Fig. 1
Recruitment of study participants. CLD = chronic lung disease. *In Greece and Kyrgyzstan, the exact number was not registered during the process. †Participants were excluded from the analysis if the outcome ‘activity impairment’ was missing
Fig. 2
Fig. 2
Work productivity and activity impairment due to CLD. CLD = chronic lung disease; WPAI = work productivity and activity impairment in median [interquartile range] %. 100% means maximum impairment. Total number of participants (numbers of employed population): Uganda N = 173 (81), Vietnam 471 (134), Kyrgyzstan 306 (40), Greece 90 (15), and total 1040 (270). Due to different population characteristics per country, data should be interpreted within the country’s context and not be used to directly compare between countries
Fig. 3
Fig. 3
Multivariable regressions per country. Mean unstandardized B (95%CI). MRC = medical research council breathlessness scale (ranging 1-5). Age (years). a Uganda, b Vietnam, c Kyrgyzstan, d Greece
Fig. 4
Fig. 4
Total multivariable regression. Mean unstandardized B (95%CI). MRC = medical research council breathlessness scale (1-5). Age (years)
Fig. 5
Fig. 5
WPAI and MRC-score. MRC = medical research council breathlessness scale (ranging 1-5). WPAI = work productivity and activity impairment in median %. Left: Activity impairment per MRC-score per country; Uganda N = 172 (1 missing MRC value), Vietnam N = 471, Kyrgyzstan N = 306, Greece N = 90, and total N = 10. Due to different population characteristics per country, data should be interpreted within the country’s context and not be used to directly compare between countries. Right: WPAI per MRC-score; Absenteeism N = 260, presenteeism N = 268, overall work impairment N = 259, activity impairment (270), total activity impairment N = 1039

References

    1. World Health Organization. Chronic respiratory diseases. 2018. . Accessed 8 Oct 2019.
    1. World Health Organization. Global Surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. 2007. . Accessed 7 Oct 2019.
    1. Pleasants RA, Riley IL, Mannino DM. Defining and targeting health disparities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2016;11:2475–2496. doi: 10.2147/COPD.S79077.
    1. Beran D, Zar HJ, Perrin C, Menezes AM, Burney P, Forum of international respiratory societies working group c Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in low-income and middle-income countries. Lancet Respir Med. 2015;3:159–170. doi: 10.1016/S2213-2600(15)00004-1.
    1. Martinez FD. Early-life origins of chronic obstructive pulmonary disease. N Engl J Med. 2016;375:871–878. doi: 10.1056/NEJMra1603287.
    1. Lee Alison G., Kaali Seyram, Quinn Ashlinn, Delimini Rupert, Burkart Katrin, Opoku-Mensah Jones, Wylie Blair J., Yawson Abena Konadu, Kinney Patrick L., Ae-Ngibise Kenneth A., Chillrud Steven, Jack Darby, Asante Kwaku Poku. Prenatal Household Air Pollution Is Associated with Impaired Infant Lung Function with Sex-Specific Effects. Evidence from GRAPHS, a Cluster Randomized Cookstove Intervention Trial. American Journal of Respiratory and Critical Care Medicine. 2019;199(6):738–746. doi: 10.1164/rccm.201804-0694OC.
    1. Townend John, Minelli Cosetta, Mortimer Kevin, Obaseki Daniel O., Al Ghobain Mohammed, Cherkaski Hamid, Denguezli Myriam, Gunesekera Kirthi, Hafizi Hasan, Koul Parvaiz A., Loh Li C., Nejjari Chakib, Patel Jaymini, Sooronbayev Talant, Buist Sonia A., Burney Peter G.J. The association between chronic airflow obstruction and poverty in 12 sites of the multinational BOLD study. European Respiratory Journal. 2017;49(6):1601880. doi: 10.1183/13993003.01880-2016.
    1. Brakema Evelyn A., Tabyshova Aizhamal, Kasteleyn Marise J., Molendijk Eveline, van der Kleij Rianne M.J.J., van Boven Job F.M., Emilov Berik, Akmatalieva Meerim, Mademilov Maamed, Numans Mattijs E., Williams Sian, Sooronbaev Talant, Chavannes Niels H. High COPD prevalence at high altitude: does household air pollution play a role? European Respiratory Journal. 2019;53(2):1801193. doi: 10.1183/13993003.01193-2018.
    1. Soriano Joan B., Polverino Francesca, Cosio Borja G. What is early COPD and why is it important? European Respiratory Journal. 2018;52(6):1801448. doi: 10.1183/13993003.01448-2018.
    1. Kurmi OP, Semple S, Simkhada P, Smith WC, Ayres JG. COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis. Thorax. 2010;65:221–228. doi: 10.1136/thx.2009.124644.
    1. Siddharthan T, Grigsby MR, Goodman D, Chowdhury M, Rubinstein A, Irazola V, Gutierrez L, Miranda JJ, Bernabe-Ortiz A, Alam D, et al. Association between household air pollution exposure and chronic obstructive pulmonary disease outcomes in 13 low- and middle-income country settings. Am J Respir Crit Care Med. 2018;197:611–620. doi: 10.1164/rccm.201709-1861OC.
    1. Glass RI, Rosenthal JP. International Approach to Environmental and Lung Health. A perspective from the Fogarty International Center. Ann Am Thorac Soc. 2018;15:S109–S113. doi: 10.1513/AnnalsATS.201708-685MG.
    1. Lopez-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology. 2016;21:14–23. doi: 10.1111/resp.12660.
    1. Brakema EA, van Gemert FA, van der Kleij R, Salvi S, Puhan M, Chavannes NH, collaborators FA COPD’s early origins in low-and-middle income countries: what are the implications of a false start? NPJ Prim Care Respir Med. 2019;29:6. doi: 10.1038/s41533-019-0117-y.
    1. Miller RL, Lawrence J. Understanding Root Causes of Asthma. Perinatal environmental exposures and epigenetic regulation. Ann Am Thorac Soc. 2018;15:S103–S108. doi: 10.1513/AnnalsATS.201706-514MG.
    1. Magitta Ng'weina Francis, Walker Richard William, Apte Komalkirti Keshavkiran, Shimwela Meshack Denson, Mwaiselage Julius David, Sanga Anna Alphonce, Namdeo Anil Kumar, Madas Sapna Jitendra, Salvi Sundeep Santosh. Prevalence, risk factors and clinical correlates of COPD in a rural setting in Tanzania. European Respiratory Journal. 2018;51(2):1700182. doi: 10.1183/13993003.00182-2017.
    1. Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res. 2017;18:67. doi: 10.1186/s12931-017-0548-3.
    1. McKee M, Balabanova D, Basu S, Ricciardi W, Stuckler D. Universal health coverage: a quest for all countries but under threat in some. Value Health. 2013;16:S39–S45. doi: 10.1016/j.jval.2012.10.001.
    1. FitzGerald J Mark, Al Efraij Khalid. Asthma in low-income and middle-income countries: an urgent call to action. Thorax. 2018;73(10):898–899. doi: 10.1136/thoraxjnl-2018-211718.
    1. Sadatsafavi M, Rousseau R, Chen W, Zhang W, Lynd L, FitzGerald JM. The preventable burden of productivity loss due to suboptimal asthma control: a population-based study. Chest. 2014;145:787–793. doi: 10.1378/chest.13-1619.
    1. van Boven JF, Vegter S, van der Molen T, Postma MJ. COPD in the working age population: the economic impact on both patients and government. COPD. 2013;10:629–639. doi: 10.3109/15412555.2013.813446.
    1. Fletcher MJ, Upton J, Taylor-Fishwick J, Buist SA, Jenkins C, Hutton J, Barnes N, Van Der Molen T, Walsh JW, Jones P, Walker S. COPD uncovered: an international survey on the impact of chronic obstructive pulmonary disease [COPD] on a working age population. BMC Public Health. 2011;11:612. doi: 10.1186/1471-2458-11-612.
    1. Miller PS, Hill H, Andersson FL. Nocturia work productivity and activity impairment compared with other common chronic diseases. Pharmacoeconomics. 2016;34:1277–1297. doi: 10.1007/s40273-016-0441-9.
    1. Grønseth Rune, Erdal Marta, Tan Wan C., Obaseki Daniel O., Amaral Andre F.S., Gislason Thorarinn, Juvekar Sanjay K., Koul Parvaiz A., Studnicka Michael, Salvi Sundeep, Burney Peter, Buist A. Sonia, Vollmer William M., Johannessen Ane. Unemployment in chronic airflow obstruction around the world: results from the BOLD study. European Respiratory Journal. 2017;50(3):1700499. doi: 10.1183/13993003.00499-2017.
    1. Rai KK, Adab P, Ayres JG, Jordan RE. Systematic review: chronic obstructive pulmonary disease and work-related outcomes. Occup Med (Lond) 2018;68:99–108. doi: 10.1093/occmed/kqy012.
    1. Cragg L, Williams S, Chavannes NH. FRESH AIR: an implementation research project funded through horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings. NPJ Prim Care Respir Med. 2016;26:16035. doi: 10.1038/npjpcrm.2016.35.
    1. Fabbri L.M., Hurd S.S. Global Strategy for the Diagnosis, Management and Prevention of COPD: 2003 update. European Respiratory Journal. 2003;22(1):1–1. doi: 10.1183/09031936.03.00063703.
    1. Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention. 2016. . Accessed 8 Jan 2018.
    1. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581–586. doi: 10.1136/thx.54.7.581.
    1. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353–365. doi: 10.2165/00019053-199304050-00006.
    1. Akinbami LJ, Sullivan SD, Campbell JD, Grundmeier RW, Hartert TV, Lee TA, Smith RA. Asthma outcomes: healthcare utilization and costs. J Allergy Clin Immunol. 2012;129:S49–S64. doi: 10.1016/j.jaci.2011.12.984.
    1. Prasad M, Wahlqvist P, Shikiar R, Shih YC. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. Pharmacoeconomics. 2004;22:225–244. doi: 10.2165/00019053-200422040-00002.
    1. Reilly Associates. WPAI Translations. 2015. . Accessed 12 Dec 2015.
    1. Rennard S, Decramer M, Calverley PM, Pride NB, Soriano JB, Vermeire PA, Vestbo J. Impact of COPD in North America and Europe in 2000: subjects’ perspective of confronting COPD international survey. Eur Respir J. 2002;20:799–805. doi: 10.1183/09031936.02.03242002.
    1. DiBonaventura M, Paulose-Ram R, Su J, McDonald M, Zou KH, Wagner JS, Shah H. The impact of COPD on quality of life, productivity loss, and resource use among the elderly United States workforce. COPD. 2012;9:46–57. doi: 10.3109/15412555.2011.634863.
    1. Gruenberger JB, Vietri J, Keininger DL, Mahler DA. Greater dyspnea is associated with lower health-related quality of life among European patients with COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:937–944. doi: 10.2147/COPD.S123744.
    1. Pavord ID, Mathieson N, Scowcroft A, Pedersini R, Isherwood G, Price D. The impact of poor asthma control among asthma patients treated with inhaled corticosteroids plus long-acting beta2-agonists in the United Kingdom: a cross-sectional analysis. NPJ Prim Care Respir Med. 2017;27:17. doi: 10.1038/s41533-017-0014-1.
    1. Zhao J, Li M, Wang Z, Chen J, Zhao J, Xu Y, Wei X, Wang J, Xie J. Role of PM2.5 in the development and progression of COPD and its mechanisms. Respir Res. 2019;20:120. doi: 10.1186/s12931-019-1081-3.
    1. Roche N, Reddel HK, Agusti A, Bateman ED, Krishnan JA, Martin RJ, Papi A, Postma D, Thomas M, Brusselle G, et al. Integrating real-life studies in the global therapeutic research framework. Lancet Respir Med. 2013;1:e29–e30. doi: 10.1016/S2213-2600(13)70199-1.
    1. Rai KK, Adab P, Ayres JG, Siebert WS, Sadhra SS, Sitch AJ, Fitzmaurice DA, Jordan RE, team* Br Factors associated with work productivity among people with COPD: Birmingham COPD cohort. Occup Environ Med. 2017;74:859–867. doi: 10.1136/oemed-2016-104014.
    1. Chen H, Blanc PD, Hayden ML, Bleecker ER, Chawla A, Lee JH, Group TS Assessing productivity loss and activity impairment in severe or difficult-to-treat asthma. Value Health. 2008;11:231–239. doi: 10.1111/j.1524-4733.2007.00229.x.
    1. Hansel NN, Romero KM, Pollard SL, Bose S, Psoter KJ, JU L, Johnson C, Williams D, Curriero FC, Breysse P, et al. Ambient air pollution and variation in multiple domains of asthma morbidity among Peruvian children. Ann Am Thorac Soc. 2019;16:348–355.
    1. Johnson KM, Bryan S, Ghanbarian S, Sin DD, Sadatsafavi M. Characterizing undiagnosed chronic obstructive pulmonary disease: a systematic review and meta-analysis. Respir Res. 2018;19:26. doi: 10.1186/s12931-018-0731-1.
    1. Heffler E, Crimi C, Mancuso S, Campisi R, Puggioni F, Brussino L, Crimi N. Misdiagnosis of asthma and COPD and underuse of spirometry in primary care unselected patients. Respir Med. 2018;142:48–52. doi: 10.1016/j.rmed.2018.07.015.
    1. Diab N, Gershon AS, Sin DD, Tan WC, Bourbeau J, Boulet LP, Aaron SD. Underdiagnosis and Overdiagnosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2018;198:1130–1139. doi: 10.1164/rccm.201804-0621CI.
    1. Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and Overdiagnosis of asthma. Am J Respir Crit Care Med. 2018;198:1012–1020. doi: 10.1164/rccm.201804-0682CI.
    1. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2:CD003793.
    1. Salvi SS, Apte KK, Dhar R, Shetty P, Faruqi RA, Thompson PJ, Guleria R. Asthma insights and Management in India: lessons learnt from the Asia Pacific - asthma insights and management (AP-AIM) study. J Assoc Physicians India. 2015;63:36–43.
    1. Ding B, Small M. Disease burden of mild asthma in China. Respirology. 2018;23:369–377. doi: 10.1111/resp.13189.
    1. Nguyen HV, Nadkarni NV, Sankari U, Mital S, Lye WK, Tan NC. Association between asthma control and asthma cost: results from a longitudinal study in a primary care setting. Respirology. 2017;22:454–459. doi: 10.1111/resp.12930.
    1. Job FM, van Boven EAB, Walusimbi S, Anastasaki M, Tabyshova A, Nguyen L, Lionis C, Tsiligianni I, Kirenga BJ, An PL, Sooronbaev T, Postma MJ, Chavannes NH. Late Breaking Abstract - Health economic burden of asthma/COPD in Uganda, Vietnam, Kyrgyzstan and Greece: FRESH AIR results. Eur Respir J: OA2911. 2017;2017:50.

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