Avaliação da incidência e do subdiagnóstico da doença pulmonar obstrutiva crônica na região metropolitana de São Paulo com base em três critérios diagnósticos espirométricos: Estudo PLATINO Seguimento
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Data
2013-09-25
Autores
Moreira, Graciane Laender [UNIFESP]
Orientadores
Jardim, José Roberto [UNIFESP]
Tipo
Tese de doutorado
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Introdução: A doença pulmonar obstrutiva crônica (DPOC), doença respiratória de alta prevalência e impacto socioeconômico no mundo, afeta aproximadamente 16% da população brasileira, dos quais 87% não foram previamente diagnosticados. Informação sobre a incidência da DPOC e atualização da taxa de subdiagnóstico desta doença é escassa na literatura e ainda desconhecida no Brasil. Objetivos: Avaliar a incidência da DPOC após nove anos de seguimento de uma amostra de base populacional na cidade de São Paulo e a taxa de subdiagnóstico nos novos casos da doença considerando três diferentes critérios diagnósticos [volume expiratório forçado no primeiro segundo/capacidade vital forçada (VEF1/CVF) < 0,70, VEF1/CVF < limite inferior da normalidade (LIN) e VEF1/VEF6 < 0,75; todos pós-broncodilatador], verificar a concordância entre esses critérios para os casos incidentes, identificar as características associadas aos novos casos da DPOC e comparar a taxa de subdiagnóstico dos casos incidentes (PLATINO seguimento) com a dos casos prevalentes (PLATINO inicial). Métodos: A população deste estudo foi composta pelos mesmos indivíduos da amostra do PLATINO inicial de São Paulo (n=1.000). Essas pessoas responderam a um questionário e foram submetidas à antropometria e espirometria pré e pósbroncodilatador utilizando-se os mesmos instrumentos e equipamentos do PLATINO inicial. As visitas foram realizadas de dezembro de 2011 a maio de 2012. A incidência cumulativa foi calculada pela razão entre número de novos casos e população em risco durante nove anos de seguimento. O teste do qui-quadrado foi utilizado para a análise da taxa de subdiagnóstico. Para investigação das características associadas à incidência da doença foi utilizado o teste do qui-quadrado/teste de Fisher ou o teste t para amostras independentes. O nível de significância adotado foi 5% (p<0,05). Resultados: Dos 1.000 sujeitos do PLATINO inicial, 613 participaram do PLATINO seguimento, pois 56 deles não foram localizados, 135 faleceram, 141 se recusaram a participar e 55 mudaram de estado/município. A incidência da DPOC, após nove anos de seguimento, variou dependendo do critério diagnóstico utilizado [VEF1/CVF<0,7 = 4,0% (n=20), VEF1/CVF<LIN = 1,4% (n=7) e VEF1/ VEF6<0,75 = 8,8% (n=43)]. Houve concordância entre os três critérios para seis novos casos da doença. A menor concordância foi entre os critérios VEF1/CVF<LIN e EF1/VEF6<0,75 (14%) e a maior entre VEF1/CVF<0,7 e VEF1/VEF6<0,75 (39,5%). As características em comum associadas aos novos casos de DPOC identificados em dois dos três critérios utilizados foram baixa escolaridade, idade mais avançada e relato do sintoma chiado. A taxa de subdiagnóstico variou de 70% a 79,1%, dependendo do critério diagnóstico, e após nove anos de seguimento houve redução de 17,5% ao se comparar a taxa de subdiagnóstico dos casos incidentes com a dos casos prevalentes. Conclusão: A incidência cumulativa da DPOC na cidade de São Paulo, após nove anos de seguimento, variou de 1,4% a 8,8%, dependendo do critério diagnóstico utilizado e a concordância entre esses critérios variou de 14% a 39,5%. As características associadas aos novos casos da DPOC foram baixa escolaridade, idade mais avançada e presença do sintoma chiado. A taxa de subdiagnóstico nos incidentes variou de 70% a 79,1% a depender do critério diagnóstico e houve redução de 17,5% ao se comparar a taxa de subdiagnóstico nos incidentes em relação aos prevalentes.
Introduction: Chronic obstructive pulmonary disease (COPD), a respiratory disease of high prevalence and socioeconomic impact in the world, affects nearly 16% of Brazilian population, of whom 87% have not been previously diagnosed. Information on COPD incidence and update on underdiagnosis rate is scarce in the literature and still not known in Brazil. Objectives: To evaluate the incidence of COPD after a nine-year follow-up of a population-based sample in Sao Paulo and the underdiagnosis rate of new cases of the disease, considering three different diagnosis criteria [forced expiratory volume in one second/forced vital capacity (FEV1/FVC<0.7), FEV1/FVC < lower limit of normal (LLN), and FEV1/FEV6<0.75; all of them post-bronchodilator], to verify the concordance among these criteria for incidence, to identify the characteristics which are associated with new cases of COPD, and compare the incident subjects’ underdiagnosis rate (PLATINO follow-up) to the prevalent subjects’ one (PLATINO baseline). Methods: The study population was composed of the same subjects from the PLATINO baseline sample of Sao Paulo (n=1,000). These people answered a questionnaire and were submitted to anthropometry and pre- and postbronchodilator spirometry by using the same tools and equipment of the PLATINO baseline study. The visits were conducted from December 2011 to April 2012. The COPD cumulative incidence was calculated by the ratio between new cases and a disease-free population during nine-years of follow-up. The chi-squared test was used to analyze the underdiagnosis rate. To investigate the characteristics associated with the new cases of COPD it was used the chisquared test/Fisher test or the independent samples t-Test. The significance level was 5% (p<0.05). Results: Out of the 1,000 subjects of the PLATINO baseline study, 613 participated in the PLATINO follow-up study because 56 were not found, 135 had died, 141 refused to participate, and 55 had moved out. The incidence of COPD, after a nine-year follow-up, varied depending on the diagnostic criteria used [FEV1/FVC<0.7 = 4.0% (n=20), FEV1/FVC<LLN = 1.4% (n=7), and FEV1/ FEV6<0.75 = 8.8% (n=43)]. There was a concordance among the diagnostic criteria in six new cases of COPD. The lower concordance was between FEV1/FVC<LLN and FEV1/FEV6<0.75 (14%) and the higher between FEV1/FVC<0.7 and FEV1/FEV6<0.75 (39.5%). The characteristics in common associated with new cases of COPD identified in two of three criteria were lower education, older age, and self-reported wheezers. The underdiagnosis rate ranged from 70% to 79.1%, depending on the diagnostic criterion, and after a nine-year follow-up there was a 17.5% reduction when comparing the underdiagnosis rate between the incident and prevalent groups. Conclusion: The incidence of COPD in Sao Paulo, after a nine-year follow-up, ranged from 1.4% to 8.8% depending on the spirometric diagnostic criterion, and the concordance among these criteria ranged from 14% to 39.5%. The characteristics associated with new cases of incidence were less educated, older age, and self-reported wheezers. The incident subjects’ underdiagnosis rate ranged from 70% to 79.1% depending on the diagnosis criterion, and there was a 17.5% reduction when comparing the underdiagnosis rate between the incident and prevalent groups.
Introduction: Chronic obstructive pulmonary disease (COPD), a respiratory disease of high prevalence and socioeconomic impact in the world, affects nearly 16% of Brazilian population, of whom 87% have not been previously diagnosed. Information on COPD incidence and update on underdiagnosis rate is scarce in the literature and still not known in Brazil. Objectives: To evaluate the incidence of COPD after a nine-year follow-up of a population-based sample in Sao Paulo and the underdiagnosis rate of new cases of the disease, considering three different diagnosis criteria [forced expiratory volume in one second/forced vital capacity (FEV1/FVC<0.7), FEV1/FVC < lower limit of normal (LLN), and FEV1/FEV6<0.75; all of them post-bronchodilator], to verify the concordance among these criteria for incidence, to identify the characteristics which are associated with new cases of COPD, and compare the incident subjects’ underdiagnosis rate (PLATINO follow-up) to the prevalent subjects’ one (PLATINO baseline). Methods: The study population was composed of the same subjects from the PLATINO baseline sample of Sao Paulo (n=1,000). These people answered a questionnaire and were submitted to anthropometry and pre- and postbronchodilator spirometry by using the same tools and equipment of the PLATINO baseline study. The visits were conducted from December 2011 to April 2012. The COPD cumulative incidence was calculated by the ratio between new cases and a disease-free population during nine-years of follow-up. The chi-squared test was used to analyze the underdiagnosis rate. To investigate the characteristics associated with the new cases of COPD it was used the chisquared test/Fisher test or the independent samples t-Test. The significance level was 5% (p<0.05). Results: Out of the 1,000 subjects of the PLATINO baseline study, 613 participated in the PLATINO follow-up study because 56 were not found, 135 had died, 141 refused to participate, and 55 had moved out. The incidence of COPD, after a nine-year follow-up, varied depending on the diagnostic criteria used [FEV1/FVC<0.7 = 4.0% (n=20), FEV1/FVC<LLN = 1.4% (n=7), and FEV1/ FEV6<0.75 = 8.8% (n=43)]. There was a concordance among the diagnostic criteria in six new cases of COPD. The lower concordance was between FEV1/FVC<LLN and FEV1/FEV6<0.75 (14%) and the higher between FEV1/FVC<0.7 and FEV1/FEV6<0.75 (39.5%). The characteristics in common associated with new cases of COPD identified in two of three criteria were lower education, older age, and self-reported wheezers. The underdiagnosis rate ranged from 70% to 79.1%, depending on the diagnostic criterion, and after a nine-year follow-up there was a 17.5% reduction when comparing the underdiagnosis rate between the incident and prevalent groups. Conclusion: The incidence of COPD in Sao Paulo, after a nine-year follow-up, ranged from 1.4% to 8.8% depending on the spirometric diagnostic criterion, and the concordance among these criteria ranged from 14% to 39.5%. The characteristics associated with new cases of incidence were less educated, older age, and self-reported wheezers. The incident subjects’ underdiagnosis rate ranged from 70% to 79.1% depending on the diagnosis criterion, and there was a 17.5% reduction when comparing the underdiagnosis rate between the incident and prevalent groups.
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Citação
MOREIRA, Graciane Laender. Avaliação da incidência e do subdiagnóstico da doença pulmonar obstrutiva crônica na região metropolitana de São Paulo com base em três critérios diagnósticos espirométricos: Estudo PLATINO Seguimento. São Paulo, 2013. 93 f. Tese (Doutorado em Medicina Translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2013.