1. The socioeconomic burden of chronic lung disease in low-resource settings across the globe – an observational FRESH AIR study
- Author
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Brakema, E.A., Tabyshova, A., Kleij, R.M.J.J. van der, Sooronbaev, T., Lionis, C., Anastasaki, M., An, P.L., Nguyen, L.T., Kirenga, B., Walusimbi, S., Postma, M.J., Chavannes, N.H., J.F.M. van boven, Akylbekov, A., Barton, A., Bertsias, A., Binh, P.D.U., J.F. van boven, Burges, D., Cartwright, L., Chatzea, V.E., Cragg, L., Dang, T.N., Dautov, I., Emilov, B., Ferarrio, I., Gemert, F.A. van, Hedrick, B., Hong, L.H.T.C., Hopkinson, N., Isaeva, E., Jones, R., Jong, C. de, Kampen, S. van, Katagira, W., Kjaergaard, J., Kleij, R.M. van der, Kocks, J., Lan, L.T.T., Linh, T.T.D., Loan, K.X., Mademilov, M., McEwen, A., Musinguzi, P., Nantanda, R., Ndeezi, G., Papadakis, S., Pinnock, H., Pooler, J., Poot, C.C., Poulsen, A., Powell, P., Quynh, N.N., Reventlow, S., Sifaki-Pistolla, D., Singh, S., Sousa, J.C. de, Stout, J., Ostergaard, M.S., Tsiligianni, I., Tuan, T.D., Tumwine, J., L.T. van, Vinh, N.N., Warren, L., Williams, S., FRESH AIR Collaborators, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), PharmacoTherapy, -Epidemiology and -Economics, Methods in Medicines evaluation & Outcomes research (M2O), and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
Lung Diseases ,Male ,Work ,IMPACT ,Respiratory System ,Global Health ,0302 clinical medicine ,Cost of Illness ,Quality of life ,QUALITY-OF-LIFE ,Uganda ,030212 general & internal medicine ,1102 Cardiorespiratory Medicine and Haematology ,ACTIVITY IMPAIRMENT ,OUTCOMES ,COPD ,Greece ,1. No poverty ,Low-income population ,ASSOCIATION ,Middle Aged ,WORK PRODUCTIVITY ,Obstructive lung disease ,Chronic respiratory disease ,3. Good health ,WPAI ,Vietnam ,Chronic lung disease ,Absenteeism ,Health Resources ,Female ,HEALTH ,Adult ,medicine.medical_specialty ,OBSTRUCTIVE PULMONARY-DISEASE ,Young Adult ,03 medical and health sciences ,Environmental health ,medicine ,Humans ,Kyrgyzstan ,Poverty ,Socioeconomic status ,Aged ,lcsh:RC705-779 ,Health economics ,business.industry ,Research ,Public health ,1103 Clinical Sciences ,lcsh:Diseases of the respiratory system ,medicine.disease ,Household air pollution ,Cross-Sectional Studies ,Social Class ,030228 respiratory system ,Chronic Disease ,Presenteeism ,ASTHMA CONTROL ,Low-resource countries ,business - 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.
- Published
- 2019
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