Patricia Alupo1, Adaeze C Wosu1,2, Abdallah Mahofa3, Levicatus Mugenyi1, Daniel Semakula3, Winceslaus Katagira1, Bruce Kirenga1,3. 1. Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public health, Baltimore, Maryland, United States of America. 3. Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Abstract
BACKGROUND: Data is lacking on outcomes among COPD patients in sub-Saharan Africa. The objective of the study was to assess the incidence and predictors of mortality among COPD patients enrolled in the Uganda Registry for Asthma and COPD. RESEARCH QUESTION: What is the Incidence and predictors of mortality among COPD patients in Uganda? STUDY DESIGN AND METHODS: Individuals with a diagnosis of COPD at six hospitals in Uganda were enrolled into the registry, and followed every six months. Mortality was ascertained through post-mortem reports and verbal autopsies. Mortality rates (MR), mortality rate ratios (MRR), and hazard ratios (HR) were computed to assess associations between socio-demographic, behavioural, and clinical characteristics at enrolment into the registry and mortality up to two years after. RESULTS: We enrolled 296 COPD patients. Median age was 60 years, and 51·3% were male. The overall mortality rate was 95·90 deaths/1000 person-years. COPD severity by post-bronchodilator FEV1 was the strongest risk factor for mortality. Compared to stage 1, adjusted hazard ratios were as follows for stage 4: 9·86 (95%CI: 1·70-57·14, p = 0·011), stage 3: 6·16 (95%CI: 1·25-30·32, p = 0·025), and stage 2: 1·76 (95%CI: 0·33-9·48, p = 0·51). Underweight patients had a higher incidence of mortality compared to normal weight patients (MRR: 3·47 (95%CI: 1·45-8·31, p = 0·0026). CONCLUSION: Among COPD patients in Uganda, two-year mortality is high, and disease severity at baseline was the strongest risk factor for mortality. Our findings suggest the need for early, accurate, diagnosis and management of COPD, to potentially improve survival.
BACKGROUND: Data is lacking on outcomes among COPDpatients in sub-Saharan Africa. The objective of the study was to assess the incidence and predictors of mortality among COPDpatients enrolled in the Uganda Registry for Asthma and COPD. RESEARCH QUESTION: What is the Incidence and predictors of mortality among COPDpatients in Uganda? STUDY DESIGN AND METHODS: Individuals with a diagnosis of COPD at six hospitals in Uganda were enrolled into the registry, and followed every six months. Mortality was ascertained through post-mortem reports and verbal autopsies. Mortality rates (MR), mortality rate ratios (MRR), and hazard ratios (HR) were computed to assess associations between socio-demographic, behavioural, and clinical characteristics at enrolment into the registry and mortality up to two years after. RESULTS: We enrolled 296 COPDpatients. Median age was 60 years, and 51·3% were male. The overall mortality rate was 95·90 deaths/1000 person-years. COPD severity by post-bronchodilator FEV1 was the strongest risk factor for mortality. Compared to stage 1, adjusted hazard ratios were as follows for stage 4: 9·86 (95%CI: 1·70-57·14, p = 0·011), stage 3: 6·16 (95%CI: 1·25-30·32, p = 0·025), and stage 2: 1·76 (95%CI: 0·33-9·48, p = 0·51). Underweight patients had a higher incidence of mortality compared to normal weight patients (MRR: 3·47 (95%CI: 1·45-8·31, p = 0·0026). CONCLUSION: Among COPDpatients in Uganda, two-year mortality is high, and disease severity at baseline was the strongest risk factor for mortality. Our findings suggest the need for early, accurate, diagnosis and management of COPD, to potentially improve survival.
Authors: Maria Montes de Oca; Gustavo Zabert; Dolores Moreno; Maria E Laucho-Contreras; Maria Victorina Lopez Varela; Filip Surmont Journal: Respir Care Date: 2017-05-30 Impact factor: 2.258
Authors: B W Allwood; R Gillespie; M Bateman; H Olckers; L Taborda-Barata; G L Calligaro; R Van Zyl-Smit; C B Cooper; N Beyers; E D Bateman Journal: S Afr Med J Date: 2018-02-01
Authors: L P Fried; R A Kronmal; A B Newman; D E Bild; M B Mittelmark; J F Polak; J A Robbins; J M Gardin Journal: JAMA Date: 1998-02-25 Impact factor: 56.272
Authors: A Sonia Buist; Mary Ann McBurnie; William M Vollmer; Suzanne Gillespie; Peter Burney; David M Mannino; Ana M B Menezes; Sean D Sullivan; Todd A Lee; Kevin B Weiss; Robert L Jensen; Guy B Marks; Amund Gulsvik; Ewa Nizankowska-Mogilnicka Journal: Lancet Date: 2007-09-01 Impact factor: 79.321
Authors: J P de Torres; C G Cote; M V López; C Casanova; O Díaz; J M Marin; V Pinto-Plata; M M de Oca; H Nekach; L J Dordelly; A Aguirre-Jaime; B R Celli Journal: Eur Respir J Date: 2008-12-01 Impact factor: 16.671
Authors: Trishul Siddharthan; Matthew R Grigsby; Dina Goodman; Muhammad Chowdhury; Adolfo Rubinstein; Vilma Irazola; Laura Gutierrez; J Jaime Miranda; Antonio Bernabe-Ortiz; Dewan Alam; Bruce Kirenga; Rupert Jones; Frederick van Gemert; Robert A Wise; William Checkley Journal: Am J Respir Crit Care Med Date: 2018-03-01 Impact factor: 30.528