The incidence of lung cancer in Northern Ireland: 1991-1992 : A comparative study.

INTRODUCTION: Lung cancer is the leading cause of cancer deaths in many Western countries, but its incidence has never been studied in Northern Ireland. AIMS: Accordingly, the present study was mounted to determine, for the first time, the incidence of the condition in Northern Ireland and to compare the findings with other regions in the British Isles. METHODS: A notification study of the incidence of lung cancer (ICD 162) was conducted in Northern Ireland during 1991/1992. Notifications from 6 sources were computerised and linked. Incident cases were identified and analysed in relation to Age, Sex and Geographical region-Northern Ireland, England and Wales, Scotland and the Republic of Ireland. RESULTS: Some 900 incident cases of lung cancer were identified. The incidence rate per 100,000 population was found to be 57.04. Mortality underestimated incidence by 12.5%. ([Formula: see text]). The male to female incidence ratio was 2.1: 1, and this ratio was similar in other regions, except Scotland, where the ratio was 1.7:1. The null hypothesis of a common incidence distribution across regions was formally rejected. A variety of models were fitted and a model in which the log-odds on incidence was a quadratic function of age fitted most of the regional data. CONCLUSIONS: Northern Ireland had the lowest incidence of lung cancer in the UK, but its overall rate was still 40% higher than that observed in the Republic of Ireland which had the lowest rate in the British Isles. Across regions, the pattern of incidence by age and sex was complicated, but a linear logistic model fitted all of the Irish data and the female data in Scotland, satisfactorily.

A systematic review of randomized controlled trials examining the short-term benefit of ambulatory oxygen in COPD.

AIM: To systematically review the short-term efficacy of ambulatory oxygen from single-assessment studies in COPD. METHODS: Searches for relevant randomized controlled trials using predefined search terms were conducted on the Cochrane Airways Group Specialized Register of RCTs, the Cochrane Central Register of Controlled Trials, and other electronically available journals, databases, and search engines. All databases were searched from their inception until December 2004. Two reviewers (J.B., B.O.) independently assessed eligibility and extracted data. All trial data were combined using RevMan analyses 4.2.8 (Cochrane Collaboration; www.cochrane.org). Due to the crossover design of the studies, data were entered using the generic inverse variance method. Fixed-effect or random-effect models were used depending on the level of statistical heterogeneity observed. RESULTS: Thirty-one studies (33 data sets; 534 participants) met the inclusion criteria of the review. Oxygen improved the primary outcomes relating to endurance and maximal exercise capacity. For the secondary outcomes of breathlessness, arterial oxygen saturation (Sao(2)), and minute ventilation (Ve), comparisons were made at isotime. Oxygen improved breathlessness, Sao(2)/Pao(2), and Ve at isotime with endurance exercise testing. For maximal exercise testing, data were not available in a format suitable for metaanalysis for breathlessness, but the improvement in Sao(2)/Pao(2) and Ve at isotime was significant. CONCLUSION: This review provides evidence from single-assessment studies that ambulatory oxygen improves exercise performance in COPD; however, the clinical importance of this size of improvement is unclear. Prior to widespread prescription of ambulatory oxygen, future research is required to establish the net long-term benefit of ambulatory oxygen in patients with different levels of hypoxemia or exercise-induced desaturation.

A Cross-Sectional Comparison of Direct Medical Care Costs among COPD and Asthma Patients Living in the Community in Northern Ireland.

INTRODUCTION: Asthma and COPD are known to have significant health and economic consequences. Little is known about the costs of the latter in the UK. In this study we report the results of a comparison of the direct medical costs associated with COPD and asthma, where diagnoses are based on a robust prevalence study of a random sample of the Northern Ireland population. METHODS: A two-stage survey was used to identify individuals with COPD and asthma. The diagnoses of asthma and COPD were based on patient history and lung function. Patients completed a detailed questionnaire covering healthcare utilization over the past 12 months, socioeconomic characteristics, impact of the disease on quality of life, and activities of daily living. RESULTS: Forty-nine patients were diagnosed with COPD and 57 with asthma. Three asthma patients were excluded from the main analysis because they were thought to have atypical inpatient stays or other resource use. The mean direct healthcare cost for each COPD patient was estimated at pound171.69 ($US309; year 2000 value) per annum, significantly less than the average cost of asthma among the 54 analyzed of pound544.54 ($US980) [p < 0.05]. A correlation analysis revealed that among COPD patients, disease severity, defined by lung function, was a significant predictor of costs. CONCLUSION: Community-based costs for asthma are greater than those for COPD; this may relate in part to a relative under-diagnosis of COPD (73.5% COPD vs 15.8% asthma). As anticipated, the cost of COPD increases as FEV(1) decreases. Further analysis will enable modeling of the cost consequences of both increased diagnosis and better management of COPD.

Prevalence of obstructive lung disease in a general population sample: the NICECOPD study.

BACKGROUND: There are little data available on the prevalence of chronic obstructive pulmonary disease (COPD) in the United Kingdom. The Northern Ireland Cost and Epidemiology of Chronic Obstructive Pulmonary Disease (NICECOPD) study is a two-stage survey to examine the prevalence of obstructive lung disease in a general population sample in the Greater Belfast area. METHODS: In stage one 4000 subjects aged 40-69 years were selected at random from the general population. They were posted a short screening questionnaire concerning respiratory symptoms. Respondents were divided into 'symptomatic' and 'asymptomatic' groups according to their responses. In stage two, a sample of symptomatic and asymptomatic subjects completed a more intensive assessment that included a detailed questionnaire on medical history, spirometry, skin allergy testing and serial peak flow measurements. Spirometric criteria for airflow obstruction were FEV1/FVC ratio of <70% with FEV1 < 80% predicted. Subjects were assigned diagnoses according to a pre-arranged protocol. RESULTS: The survey was conducted from May 1999 to May 2001. There was a 67% response rate to the stage 1 screening questionnaire and 1330 responders were identified as being eligible to take part in stage 2. In total, 722 subjects completed a detailed assessment (50.8% Male, symptomatic, n = 326; asymptomatic, n = 396). COPD was diagnosed in 12.3% (8.8, 15.8) of the symptomatic and 2.2% (0.8, 3.6) of the asymptomatic group. The estimated prevalence of obstructive lung disease in the total population age 40-69 years was 14.4%: 6.3% COPD; 7.2% asthma; 0.9% with indeterminate airflow obstruction. In men, the prevalence of COPD varied from 4.9% in those aged 40-49 years to 12.3% in those aged 60-69 years and in women, varied from 1.4% in 40-49 years of age to 4.5% in 60-69 years. CONCLUSION: The data suggest that COPD and asthma are common conditions in the general population and should inform future plans to address the burden of disease.