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1. Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients

Author

Corrado Zenesini, Sabrina Angelini, Silvana Hrelia, Alessandro Zanasi, Muriel Assunta Musti, Paolo Pandolfi, Elisa Stivanello, Cristina Angeloni, Lara Pisani, Patrizia Hrelia, Francesca Maffei, Pandolfi P, Zanasi A, Musti MA, Stivanello E, Pisani L, Angelini S, Maffei F, Hrelia S, Angeloni C, Zenesini C, and Hrelia P

Subjects
Male, Spirometry, medicine.medical_specialty, lcsh:Medicine, Kaplan-Meier Estimate, Severity of Illness Index, Pulmonary Disease, Chronic Obstructive, Risk Factors, Internal medicine, Severity of illness, medicine, COPD, Humans, Respiratory function, Intensive care medicine, lcsh:Science, Life Style, Survival analysis, Aged, Proportional Hazards Models, Multidisciplinary, Anthropometry, medicine.diagnostic_test, Proportional hazards model, business.industry, Body Weight, lcsh:R, Middle Aged, medicine.disease, respiratory tract diseases, Hospitalization, Social Class, Disease Progression, Female, lcsh:Q, Underweight, medicine.symptom, business, Body mass index, Research Article
Abstract

Background Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients. Methods Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant’Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines. Results 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01–16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52–8.83), belonging to moderate (HR = 3.50; 95% CI 1.01–12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35–28.85). Conclusions Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.

Published
2015

2. Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries

Author

Martina Taglioni, Eugene Declercq, Elisa Stivanello, Giulia Pieri, Maria Pia Fantini, Chiara Seghieri, Elisa Carretta, Sabina Nuti, Paola Rucci, Stivanello E., Rucci P., Carretta E., Pieri G., Seghieri C., Nuti S., Declercq E., Taglioni M., and Fantini MP.

Subjects
medicine.medical_specialty, Non-Clinical Medicine, Epidemiology, Caesarean delivery, Human immunodeficiency virus (HIV), lcsh:Medicine, medicine.disease_cause, Labor and Delivery, Pregnancy, Risk Factors, Medicine, Humans, Clinical Epidemiology, Maternity service, lcsh:Science, Epidemiological Methods, Gynecology, Multidisciplinary, Evidence-Based Medicine, business.industry, Singleton, Obstetrics, Cesarean Section, Mortality rate, lcsh:R, Obstetrics and Gynecology, Risk adjustment, medicine.disease, Hospitals, Socioeconomic Aspects of Health, Italy, Female, Risk Adjustment, lcsh:Q, Health Services Research, Public Health, business, Obstetric Surgery, Research Article
Abstract

BACKGROUND: Caesarean delivery (CD) rates have been frequently used as quality measures for maternity service comparisons. More recently, primary CD rates (CD in women without previous CD) or CD rates within selected categories such as nulliparous, term, cephalic singleton deliveries (NTCS) have been used. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries. METHODS: Hospital discharge records of women who delivered in Emilia-Romagna Region (Italy) from January, 2007 to June 2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined. RESULTS: Adjusted RR differed substantially from crude RR in women without a previous Caesarean and only marginally in NTCS group. Hospital ranking was markedly affected by adjustment in women without a previous CD, but less in NTCS. CONCLUSION: Risk adjustment is warranted for inter-hospital comparisons of primary CD rates but not for NTCS CD rates. Crude NTCS CD rates are a reliable estimate of adjusted NTCS CD.

Published
2011

3. Socio-Economic and Clinical Factors as Predictors of Disease Evolution and Acute Events in COPD Patients.

Author

Pandolfi P, Zanasi A, Musti MA, Stivanello E, Pisani L, Angelini S, Maffei F, Hrelia S, Angeloni C, Zenesini C, and Hrelia P

Subjects
Aged, Anthropometry, Body Weight, Disease Progression, Female, Hospitalization, Humans, Kaplan-Meier Estimate, Life Style, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Severity of Illness Index, Spirometry, Pulmonary Disease, Chronic Obstructive economics, Pulmonary Disease, Chronic Obstructive epidemiology, Social Class
Abstract

Background: Socio-economic, cultural and environmental factors are becoming increasingly important determinants of chronic obstructive pulmonary disease (COPD). We conducted a study to investigate socio-demographic, lifestyle and clinical factors, and to assess their role as predictors of acute events (mortality or hospitalization for respiratory causes) in a group of COPD patients., Methods: Subjects were recruited among outpatients who were undertaking respiratory function tests at the Pneumology Unit of the Sant'Orsola-Malpighi Hospital, Bologna. Patients were classified according to the GOLD Guidelines., Results: 229 patients with COPD were included in the study, 44 with Mild, 68 Moderate, 52 Severe and 65 Very Severe COPD (GOLD stage). Significant differences among COPD stage, in terms of smoking status and fragility index, were detected. COPD stage significantly affected the values of all clinical tests (spirometry and ABG analysis). Kaplan-Meier estimates showed a significant difference between survival curves by COPD stage with lower event-free probability in very severe COPD stage. Significant risk factors for acute events were: underweight (HR = 4.08; 95% CI 1.01-16.54), having two or more comorbidities (HR = 4.71; 95% CI 2.52-8.83), belonging to moderate (HR = 3.50; 95% CI 1.01-12.18) or very severe COPD stage (HR = 8.23; 95% CI 2.35-28.85)., Conclusions: Our findings indicate that fragility is associated with COPD stage and that comorbidities and the low body mass index are predictors of mortality or hospitalization. Besides spirometric analyses, FeNO measure and comorbidities, body mass index could also be considered in the management and monitoring of COPD patients.

Published
2015
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4. Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries.

Author

Stivanello E, Rucci P, Carretta E, Pieri G, Seghieri C, Nuti S, Declercq E, Taglioni M, and Fantini MP

Subjects
Female, Humans, Italy epidemiology, Pregnancy, Risk Factors, Cesarean Section statistics & numerical data, Hospitals statistics & numerical data, Risk Adjustment statistics & numerical data
Abstract

Background: Caesarean delivery (CD) rates have been frequently used as quality measures for maternity service comparisons. More recently, primary CD rates (CD in women without previous CD) or CD rates within selected categories such as nulliparous, term, cephalic singleton deliveries (NTCS) have been used. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries., Methods: Hospital discharge records of women who delivered in Emilia-Romagna Region (Italy) from January, 2007 to June 2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined., Results: Adjusted RR differed substantially from crude RR in women without a previous Caesarean and only marginally in NTCS group. Hospital ranking was markedly affected by adjustment in women without a previous CD, but less in NTCS., Conclusion: Risk adjustment is warranted for inter-hospital comparisons of primary CD rates but not for NTCS CD rates. Crude NTCS CD rates are a reliable estimate of adjusted NTCS CD.

Published
2011
Full Text
View/download PDF

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