Prevalência de DPOC em Florianópolis e fatores associados: estudo de base populacional

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2015.Introdução: O impacto global da Doença Pulmonar Obstrutiva Crônica (DPOC) é notável em termos de morbimortalidade, custos econômicos e diminuição de qualidade de vida. Dados epidemiológicos da DPOC no Brasil ainda sao escassos. Pesquisas neste sentido podem oferecer embasamento para futuras formulações de políticas públicas de saúde, prevenção e assistência aos portadores desta doença. Objetivo: Verificar a prevalência da DPOC e fatores associados em Florianópolis. Métodos: Este é um estudo de base populacional (Respira Floripa), representativo dos moradores da cidade de Florianópolis com =40 anos, cuja metodologia foi baseada no estudo PLATINO. Os instrumentos de avaliação utilizados no estudo compreenderam entrevista domiciliar, medidas antropométricas e espirometria. O diagnóstico funcional de DPOC foi realizado por espirometria (VEF1/CVF Abstract : Introduction: The Global impact of Chronic Obstructive Pulmonary Disease (COPD) is remarkable in terms of morbidity, economic costs and decreased quality of life. Epidemiological data of COPD in Brazil are still scarce. Additional research on this issue may provide insights for future formulations of public health policies, prevention and care for patients with this disease. Objective: To determine the prevalence of COPD and associated factors in Florianopolis. Methods: This is a population-based study (Respira Floripa), representative of Florianopolis citizens, aged equal or over 40 years, whose methodology was based on the PLATINUM study. Assessment instruments comprised household interviews, anthropometric measurements and spirometry. Functional diagnosis of COPD was performed by spirometry (postbronchodilator FEV1/ FVC <0.70). Results are expressed as percentage or prevalence ratio (PR) and of 95% confidence interval (95% CI). Differences between categorical variables were analyzed using the Chi-square test. The comparison of three or more groups was preformed by analysis of variance (ANOVA) and, when the difference was statistically significant, the source of the differences was identified by post-hoc analysis with Bonferroni test. Multivariate analysis was used to identify factors associated with COPD. Robust Poisson regression (generalized linear model - GLM) was used to estimate the crude and adjusted effects of risk factors for COPD. All statistical tests were twotailed used and the significance level was 5% (p <0.05). Results: The prevalence of COPD in the study population (n = 1059) was 8.7%. The rate of under-diagnosis was 71.7%. The prevalence of COPD was significantly higher in men than in women (12.3 vs. 6.3, p = 0.005) in subjects aged = 60 years than in those aged 40-49 or those aged 50-59 years (13.3 vs. 2.4 vs. 8.45%, respectively, p <0.001) and in those with schooling = 4 years compared with those who had 5-9 years or = 9 years of education (14.3 vs. 7.9 vs. 6.5%, respectively, p <0.001). Furthermore, the prevalence of COPD was significantly higher in smokers or former smokers than in nonsmokers (14.4 vs. 3.6%, respectively, p <0.001). Multivariate analysis showed that factors associated with COPD were being a smoker or ex-smoker vs. non-smokers (PR = 2.4 and 95% CI (1.3 to 4.3), p = 0.002), smoking history = 40 vs. <20 packs / year (PR = 1.9 and 95% CI (1.1 to 3.8), p = 0.01), education 0-4 years vs. = 9 years (PR = 1.5 and 95% CI (1.0 - 1.3) p = 0.01), hospitalization for respiratory problem up to 10 years of age (PR = 2.4 and 95% CI (1.4 to 2.5), p = 0.03), previous diagnosis of asthma (PR = 3.0 95% and CI (1.9 to 4.5), p