The problem of chronic obstructive pulmonary disease, disease burden and social burden

In this publication, based on the available literature sources, current data on the prevalence, morbidity and mortality from chronic obstructive pulmonary disease, the economic and social burden caused by this disease throughout the world are considered. The article also highlights the situation in Uzbekistan regarding this disease. According to the data given by the authors, chronic obstructive pulmonary disease is one of the urgent problems of modern society, which needs to be researched in this direction.

Keywords: chronic obstructive pulmonary disease, COPD, distribution, morbidity, mortality, economic burden, social burden, disease burden.

From year to year, the growth of chronic respiratory diseases is observed all over the world. The main reason for the high prevalence of chronic respiratory diseases is that the respiratory system is the body's primary protective barrier. That is why the respiratory system almost instantly reacts to the damaging effects of toxic-allergic, infectious and physical environmental factors [12]. At the moment, respiratory diseases are a global medical, social and economic problem in all industrialized countries, due to the progressive and disabling course of these pathologies [6, 5].

The most common chronic disease of the respiratory system among the adult population, which can lead to temporary disability and death of patients, is considered chronic obstructive pulmonary disease [17, 21, 22, 24]. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. It is also considered to be a socially and economically significant problem (Mannino D. M., 2007). The reason for this was a steady decrease in the quality of life of patients as a result of chronic obstructive pulmonary disease, as a result of which early disability occurs in 13 % [22, 23], and a progressive increase in mortality is observed. This, accordingly, leads to an increase in the costs of the health care system for lifelong use of drugs, expensive emergency medical care, long periods of disability and disability payments [10].

COPD prevalence

According to the Global Burden of Disease Study, in 2016 the prevalence of COPD in the world was 251 million cases [11]. WHO estimates that 65 million people currently suffer from chronic obstructive pulmonary disease in moderate to severe form [4]. Back in 1999, based on the research of various scientists, it was known that from 4–6 % to 10–25 % of the adult population suffers from this disease (Buist S. A., 1999). Currently, the global incidence of chronic obstructive pulmonary disease is estimated at 10 % among adults over 40 years of age [14]. Every year there is a steady increase in the prevalence of this disease in both developed and developing countries. According to many scientists, the increase in the prevalence of COPD around the world in recent years, which is especially pronounced in developed and developing countries, is primarily due to an increase in tobacco smoking, as well as a change in the age structure of the population, namely “population aging”. In addition, environmental pollution plays an important role (Ignatiev V. A., Titova O. N., Gultyaeva O. I., 2007).

The above data on the prevalence of chronic obstructive pulmonary disease are conditional. Data on the true number of patients with COPD in the world are rather contradictory. The reason for this discrepancy is that examination methods, diagnostic criteria and analytical approaches vary from country to country (Mathers C. D., Loncar D., 2006). In most studies, COPD was defined by spirometry alone and not by a combination of symptoms and spirometry. But in some cases, until now, estimates of the prevalence of COPD in the population are still based on expert opinion or a diagnosis that was made only on the basis of a medical examination. In addition, COPD is not always diagnosed at an earlier stage, and not all people report their disease. Some data show that less than 6 % of adults report having COPD (Halbert R. J., 2006). Thus, most often, the results of the prevalence of COPD depend on the level of activity of health care in a particular country in relation to this disease. That is why it should not be ruled out that the actual prevalence of COPD may be higher than the data indicated in official health sources.

Incidence of COPD

The incidence of COPD can vary markedly not only in different countries, but also in different regions of the same country. All this can be directly related to the prevalence of tobacco smoking in a particular region or country. Initially, chronic obstructive pulmonary disease primarily affected men, but now the disease affects both men and women almost equally [4]. The increase in the number of women suffering from COPD is explained by the widespread use of tobacco among females around the world (Chuchalin A. G. et al., 2008). In addition, an increase in the number of women with COPD is observed due to the influence of household pollutants, which lead to the development of this disease (Mannino D. M., 2002). By 2025, more than 500 million women are expected to be smokers. This is approximately 20 % of the female population of the planet. According to world statistics, mortality from chronic obstructive pulmonary disease among women is higher than from breast cancer and lung cancer (Ovcharenko S. I., Kapustina V. A., 2010).

Chronic obstructive pulmonary disease occurs most frequently in the population over the age of 60, but cases of the disease also occur at a younger age. According to a large international study by Burden of Obstructive lung Disease (BOLD), the prevalence of chronic obstructive pulmonary disease in the world among people over 40 years of age is approximately 10 % [19]. Also, cases of the development of this disease from the age of 25 were recorded [20].

Mortality is considered to be the most informative indicator among all epidemiological indicators. The World Health Organization annually publishes statistics on mortality from various causes. Chronic obstructive pulmonary disease is far from the last place in this list. COPD is one of the few diseases, the death rate from which only increases every year (Fennelly K. P., 1994).

According to WHO estimates, in the period from 1990 to 2010, an average of 2.8–3 million people died from this disease every year [14, 17], and in the case of patients older than 65 years, the mortality rate was 28 % [13]. By 2015, this number had increased. It was recorded that 3.17 million people died of COPD worldwide in 2015, which accounted for about 5 % of all deaths in the world that year. In general, over 90 % of COPD deaths occur in low- and middle-income countries [11]. The number of people who die from chronic obstructive pulmonary disease is growing every year. If in 2002 this disease was the fifth leading cause of death [4], then at the moment chronic obstructive pulmonary disease is the third leading cause of death worldwide. This disease accounts for approximately 6 % of the total number of deaths, respectively [1].

With increasing prevalence of smoking in developing countries and aging populations in developed countries, the prevalence of chronic obstructive pulmonary disease is expected to increase over the next forty years, with more than 5.4 million deaths each year from COPD by 2060 (Lopez A. D., 2006) [26].

Economic and social burden from COPD

As mentioned above, at the moment, chronic obstructive pulmonary disease is considered one of the most common chronic inflammatory diseases in the world, which is characterized by a steady decline in the quality of life with a progressive increase in the death rate [8]. It was found that every fourth patient with chronic obstructive pulmonary disease becomes disabled ten years after the diagnosis. The life expectancy of disabled people is rather short and can be approximately 8 years [7].

The economic burden of treating diseases that are accompanied by broncho -obstructive syndrome, including chronic obstructive pulmonary disease, has been repeatedly calculated by specialists in various countries. It was found that the economic losses from this disease account for 2/3 of labor losses from all chronic nonspecific lung diseases. Due to the fact that COPD is a steadily progressive chronic disease of the pulmonary system, there is a need for long-term and permanent treatment. Treatment, in turn, is accompanied by large material costs on the part of the healthcare system, patients, their families and society as a whole [3].

That is why WHO classifies chronic obstructive pulmonary disease as a disease that has a high level of socio-economic burden for society, patients and their families [15].

According to European Union estimates, the total direct cost of respiratory diseases is about 6 % of the total annual health care budget, with COPD accounting for 56 % (€38.6 billion) of respiratory disease costs [16].

The estimated direct cost in the US for COPD is approximately $32 billion, and the indirect costs associated with disability and mortality are about $20.4 billion [18]. The main expenses for COPD were directed to the hospitalization of patients.

COPD exacerbations account for the largest portion of the overall burden of COPD on the health care system. It has been found that there is a direct relationship between the severity of COPD and the cost of treatment, with the distribution of costs changing as the disease progresses. For example, the cost of hospitalization and outpatient care for COPD patients increases as the severity of COPD increases.

COPD in Uzbekistan

At the moment, large-scale work is being carried out in Uzbekistan to prevent the development of respiratory diseases, including chronic obstructive pulmonary disease. Improving the healthcare system in this direction is one of the most important issues at the present time. This is necessary due to the increase in the incidence of respiratory diseases both in Uzbekistan and around the world. This is especially true for chronic obstructive pulmonary disease. Respiratory diseases in the Republic of Uzbekistan occupy the first place in the structure of the incidence of the population. Mortality from respiratory diseases ranks second in the country, yielding first place to cardiovascular diseases [25].

According to some authors, the prevalence of chronic obstructive pulmonary disease in the Republic of Uzbekistan is approximately 67–168 cases per 10,000 population of the country [2,9]. It is known that the prevalence of COPD in the Republic of Uzbekistan is 4.8 per 100 examined. At the same time, 7.0 per 100 is observed among men, and 2.2 per 100 among women. This figure increases with age. For men, this figure is:

— 0.8 per 100 examined aged 30–39 years,

— 5.3 per 100 examined at 40–49 years old,

— 13.0 per 100 examined at 50–59,

— 22.5 per 100 examined at 60 years of age and older.

Among women, the prevalence is:

— 1.8 per 100 examined aged 40–49 years

— 3.9 per 100 examined aged 50–59 years,

The main risk factor for the development of the disease is smoking, the frequency of which is 49.6 per 100 examined. Among men, the frequency of occurrence of this risk factor in men is 73.4 per 100, in women 20.5 per 100 examined [9].

As in other countries, COPD in Uzbekistan causes great economic burden. COPD is one of the top four non-communicable diseases that cause enormous burden to the country's economy. In 2016, non-communicable diseases caused economic loss to the country in the amount of 9.3 trillion soums. This is equivalent to 4.7 % of the country's gross domestic product [25].

That is why the country pays great attention to the optimization of measures for early diagnosis of the risk of complications and the development of new methods of COPD treatment. Due to this, it will be possible to reduce the rates of disability and mortality in this disease.

Conclusion

Summarizing the materials that were presented in the article, chronic obstructive pulmonary disease leads to significant economic and social burden throughout the world, the level of which is increasing every year. The reason for this is its high prevalence, morbidity and mortality. COPD is not only a medical, but also a socio-economic problem in all countries of the world. COPD is characterized by a steady decline in quality of life with a progressive increase in mortality. COPD is considered one of the few diseases in which mortality is only increasing every year. That is why in most countries of the world the healthcare system pays great attention to this disease.

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