Prevalence and burden of obstructive lung disease in the urban poor population of Ottawa, Canada: a community-based mixed-method, observational study

Smita Pakhale, Saania Tariq, Nina Huynh, Sadia Jama, Tina Kaur, Catherine Charron, Kelly Florence, Fozia Nur, Margaret Ella Bustamante-Bawagan, Ted Bignell, Robert Boyd, Joanne Haddad, Tetyana Kendzerska, Gonzalo Alvarez, Smita Pakhale, Saania Tariq, Nina Huynh, Sadia Jama, Tina Kaur, Catherine Charron, Kelly Florence, Fozia Nur, Margaret Ella Bustamante-Bawagan, Ted Bignell, Robert Boyd, Joanne Haddad, Tetyana Kendzerska, Gonzalo Alvarez

Abstract

Background: Globally the burden of Obstructive Lung Diseases (OLD) is growing, however its effect on urban poor populations with the high prevalence of tobacco dependence is virtually unknown. The purpose of this project is to estimate the prevalence and burden of OLD in the urban, low-income populations of Ottawa, Canada.

Methods: The study presented in this paper was part of the PROMPT (Management and Point-of-Care for Tobacco Dependence) project; a prospective cohort study in a community-based setting (n = 80) with meaningful Patient Engagement from design to dissemination. Spirometry data, standardized questionnaires and semi-structured interviews from PROMPT were interpreted to understand the lung function, disease burden and social determinants (respectively) in this population.

Results: The prevalence of OLD among those who completed spirometry (N = 64) was 45-59%. Generic and disease-specific quality of life was generally poor in all PROMPT participants, even those without OLD, highlighting the higher disease burden this vulnerable population faces. Quality of life was impacted by two major themes, including i) socioeconomic status and stress and ii) social networks and related experiences of trauma.

Conclusion: The prevalence and disease burden of OLD is significantly higher in Ottawa's urban poor population than what is observed in the general Canadian population who smoke, suggesting an etiological role of the social determinants of health. This urges the need for comprehensive care programs addressing up-stream factors leading to OLDs, including poor access and utilization of preventive healthcare addressing the social determinants of health.

Trial registration: ClinicalTrails.gov - NCT03626064 , Retrospective registered: August 2018.

Keywords: Obstructive lung disease; Social determinants of health; Urban poor.

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Hajnal ZL. The nature of concentrated urban poverty in Canada and the United States. Can J Sociol / Cah Can Sociol. 1995;20(4):497. doi: 10.2307/3341855.
    1. Burki TK. Homelessness and respiratory disease. Lancet Respir Med. 2017;1(10):767–768. doi: 10.1016/S2213-2600(13)70267-4.
    1. Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, et al. Inequalities in non-communicable diseases and effective responses. Lancet. 2017;381(9866):585–597. doi: 10.1016/S0140-6736(12)61851-0.
    1. Stringhini S, Carmeli C, Jokela M, Avendao M, Muennig P, Guida F, et al. Socioeconomic status and the 25x25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women. Lancet. 2017.
    1. Snyder LD, Eisner MD. OBstructive lung disease among the urban homeless*. Chest. 2004;125(5):1719–1725. doi: 10.1378/chest.125.5.1719.
    1. Tsai J, Rosenheck RA. Smoking among chronically homeless adults: prevalence and correlates. Psychiatr Serv. 2012;63(6):569–576. doi: 10.1176/appi.ps.201100398.
    1. Pakhale S, Kaur T, Rose T, Florence K, LeBlanc S, Muckle W, et al. The PROMPT study: participatory research in Ottawa: management and point-of-care of tobacco-a community-based participatory action research project. BMJ Open. 2017.
    1. Vijayaraghavan M, Tieu L, Ponath C, Guzman D, Kushel M. Tobacco cessation behaviors among older homeless adults: results from the HOPE HOME study. Nicotine Tob Res. 2016;18(8):1733–1739. doi: 10.1093/ntr/ntw040.
    1. Vijayaraghavan M, Pierce JP. Interest in smoking cessation related to a smoke-free policy among homeless adults. J Community Health. 2015;40(4):686–691. doi: 10.1007/s10900-014-9985-9.
    1. Chetty R, Stepner M, Abraham S. The association between income and life expectancy in the United States, 2001-2014. JAMA. 2016;315(16):1750–1766. doi: 10.1001/jama.2016.4226.
    1. Leone FT, Carlsen K-H, Chooljian D, Alexander LEC, Detterbeck FC, Eakin MN, et al. Recommendations for the appropriate structure, communication, and investigation of tobacco harm reduction claims an official American thoracic society policy statement. Am J Respir Crit Care Med. 2018;198(8).
    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease 2017 report. Respirology. 2017;22(3):575–601. doi: 10.1111/resp.13012.
    1. Preteroti M, Whitmore GA, Vandemheen KL, FitzGerald JM, Lemière C, Boulet LP, et al. Population-based case-finding to identify subjects with undiagnosed asthma or COPD. Eur Respir J. 2020;55(6).
    1. Martinez CH, Mannino DM, Curtis JL, Han MK, Diaz AA. Socioeconomic characteristics are major contributors to ethnic differences in health status in obstructive lung disease: an analysis of the National Health and Nutrition Examination Survey 2007-2010. CHEST J. 2015;148(1):151–158. doi: 10.1378/chest.14-1814.
    1. Celedon JC, Burchard EG, Schraufnagel D, Castillo-Salgado C, Schenker M, Balmes J, et al. An American Thoracic Society/National Heart, Lung, and Blood Institute Workshop Report: addressing respiratory health equality in the United States. Ann Am Thorac Soc. 2017;14(5):814–826. doi: 10.1513/AnnalsATS.201702-167WS.
    1. Pakhale S, Kaur T, Florence K, Rose T, Boyd R, Haddad J, et al. The Ottawa Citizen Engagement and Action Model (OCEAM): a citizen engagement strategy operationalized through the Participatory Research in Ottawa, Management and Point-of-care of Tobacco (PROMPT) study. Res Involv Engagem. 2016;2(1):1–18. doi: 10.1186/s40900-016-0034-y.
    1. Charron CB, Hudani A, Kaur T, Rose T, Florence K, Jama S, et al. Assessing community (peer) researcher’s experiences with conducting spirometry and being engaged in the ‘Participatory Research in Ottawa: Management and Point-of-care for Tobacco-dependence’(PROMPT) project. Res Involv Engagem. 2018;4(1):43. doi: 10.1186/s40900-018-0125-z.
    1. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. SERIES “‘ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING’” Number 5 in this Series Interpretative strategies for lung function tests. Brusasco V, Crapo R, Viegi G, editors. Eur Respir J. 2005;26:948–968. doi: 10.1183/09031936.05.00035205.
    1. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999;159.
    1. REPORT FROM THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM. Asthma and chronic obstructive pulmonary disease (COPD) in Canada, 2018. Ottawa; 2018.
    1. Ismaila AS, Sayani AP, Marin M, Su Z. Clinical, economic, and humanistic burden of asthma in Canada: a systematic review. BMC Pulm Med. 2013;13(1):70. doi: 10.1186/1471-2466-13-70.
    1. Mittmann N, Kuramoto L, Seung SJ, Haddon JM, Bradley-Kennedy C, FitzGerald JM. The cost of moderate and severe COPD exacerbations to the Canadian healthcare system. Respir Med. 2008;102(3):413–421. doi: 10.1016/j.rmed.2007.10.010.
    1. Burney P, Jithoo A, Kato B, Janson C, Mannino D, Nizankowska-Mogilnicka E, et al. Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty-a bold analysis. Thorax. 2014;69(5):465–473. doi: 10.1136/thoraxjnl-2013-204460.
    1. Drummond MB, Kirk GD, Astemborski J, McCormack MC, Marshall MM, Mehta SH, et al. Prevalence and risk factors for unrecognized obstructive lung disease among urban drug users. Int J COPD. 2011;6(1):89–95. doi: 10.2147/COPD.S15968.
    1. Chronic Obstructive Pulmonary Disease (COPD) in Canada . Government of Canada, Data Blog. 2018.
    1. van Dijk W, Tan W, Li P, Guo B, Li S, Benedetti A, et al. Clinical relevance of fixed ratio vs lower limit of normal of FEV (1)/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med. 2015;13(1):41–48. doi: 10.1370/afm.1714.
    1. Houben-Wilke S, Janssen DJA, Franssen FME, Vanfleteren LEGW, Wouters EFM, Spruit MA. Contribution of individual COPD assessment test (CAT) items to CAT total score and effects of pulmonary rehabilitation on CAT scores. Health Qual Life Outcomes. 2018;16(1):205. doi: 10.1186/s12955-018-1034-4.
    1. Atis Nayci S, Ozgur E, Ozge C. Socioeconomic status shaping GOLD A-D classification in patients with chronic obstructive pulmonary disease. In: European Respiratory Journal: European Respiratory Society (ERS); 2016. p. PA3683.
    1. Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, et al. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health. 2011;65(1):26–34. doi: 10.1136/jech.2009.089722.
    1. Prescott E, Vestbo J. Socioeconomic status and chronic obstructive pulmonary disease. Thorax. 1999;54:737–741. doi: 10.1136/thx.54.8.737.
    1. Disler R, Green A, Luckett T, Newton P, Inglis S, Currow D, et al. Experience of advanced chronic obstructive pulmonary disease: metasynthesis of qualitative research. J Pain Symptom Manag. 2014;48(6):1182–1199. doi: 10.1016/j.jpainsymman.2014.03.009.
    1. Hwang SW, Ueng JJM, Chiu S, Kiss A, Tolomiczenko G, Cowan L, et al. Universal health insurance and health care access for homeless persons. Am J Public Health. 2010;100(8):1454–1461. doi: 10.2105/AJPH.2009.182022.
    1. Baggett TP, O’Connell JJ, Singer DE, Rigotti NA. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010;100(7):1326–1333. doi: 10.2105/AJPH.2009.180109.
    1. National Academies of Sciences E and M, Division H and M, Practice B on PH and PH, States C on C-BS to PHE in the U. Baciu A, Negussie Y, et al. The Root Causes of Health Inequity. 2017.
    1. About the Framework | National Lung Health Framework. Available from: . Accessed 22 Dec 2020.
    1. How the National Lung Health Framework’s Database Can Help You. Available from: . Accessed 22 Dec 2020.
    1. Harris DA, Pensa MA, Redlich CA, Pisani MA, Rosenthal MS. Community-based participatory research is needed to address pulmonary health disparities. Ann Am Thorac Soc. 2016;13(8):1231–1238. doi: 10.1513/AnnalsATS.201601-054PS.
    1. Hwang SW, Aubry T, Palepu A, Farrell S, Nisenbaum R, Hubley AM, et al. The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities. Int J Public Health. 2011;56(6):609–623. doi: 10.1007/s00038-011-0283-3.
    1. Vijayaraghavan M, Jacobs EA, Seligman H, Fernandez A. The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults. J Health Care Poor Underserved. 2011;22(4):1279–1291. doi: 10.1353/hpu.2011.0131.
    1. Wiebel WW, Jimenez A, Johnson W, Ouellet L, Jovanovic B, Lampinen T, et al. Risk behavior and HIV seroincidence among out-of-treatment injection drug users: a four-year prospective study. JAIDS J Acquir Immune Defic Syndr. 1996;12(3):282–289. doi: 10.1097/00042560-199607000-00008.
    1. Argintaru N, Chambers C, Gogosis E, Farrell S, Palepu A, Klodawsky F, et al. A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities. BMC Public Health. 2013;13:577. doi: 10.1186/1471-2458-13-577.
    1. George S, Duran N, Norris K. A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. Am J Public Health. 2014;104(2):e16–e31. doi: 10.2105/AJPH.2013.301706.
    1. Anderson I, Filipovič Hrast M, Finnerty J. Researching homelessness: Challenging exclusion? Vol. 4, Social Inclusion: Cogitatio Press; 2016. p. 1–4.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever