Lung Diseases

Introduction:
According to the American Lung Society, Chronic Obstructive Pulmonary Disease (COPD) is the sixth leading cause of death in the United States. In 2020, it claimed the lives of 148,512 people, making it the fifth leading disease-related cause of death after heart disease, cancer, COVID-19, accidents, and stroke [5]. COPD is a group of conditions, including chronic bronchitis and emphysema, that obstruct airflow and make breathing difficult. It is estimated to affect nearly 16 million adults in the United States, many unaware they have it. Shockingly, more than half of those diagnosed are women, and it is now the sixth leading cause of death in the US, according to the Centers for Disease Control and Prevention [4].
While the mortality rate due to COPD decreased among men in the USA between 1999 and 2006, there was no decrease in mortality among women [2]. This disease, once thought to affect men and older adults primarily, has now been found to impact women as well. In fact, over half of all COPD diagnoses in the US are women. It is important to note that COPD ranks higher than lung cancer and cardiovascular diseases, which is a significant concern given the increasing number of women being diagnosed with the condition. After researching and analyzing the dataset, I identified several areas of interest—however, I needed more information to gain valuable insights. Data was extracted from data.gov and found an association between women and chronic obstructive pulmonary disease (COPD) in the United States. The question then asked if this was an anomaly or if there was evidence of gender bias in the diagnosis of COPD, and the disease is more prevalent among women.
This secondary research aimed to identify potential patterns or trends in chronic health indicators (CDI) that could be observed through data analysis. This research methodology was exploratory and secondary, which aimed to investigate research questions that have yet to be studied. Although the analyzed dataset was intended to be qualitative and primary, its size allowed for a large sample study conducted in an exploratory manner, which can also be considered quantitative. It is a research method that involves compiling existing data from various channels.
Method:
Tableau was used to search for new insights by analyzing data from data.gov and the US Chronic Disease Indicator. This standardized measure provides nationwide data on chronic diseases and risk factors significantly impacting public health. The data is a consensus among the CDC and other partners and is crucial for the prioritization, surveillance, and evaluating of public health interventions.
The indicator comprises 124 chronic diseases and risk factors across eighteen topic groups, which include alcohol, arthritis, asthma, cancer, cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunization, nutrition, physical activity, weight status, oral health, tobacco, overarching conditions, and new topic areas such as disability, mental health, older adults, reproductive health, and school health. The 124 indicators include 201 individual measures that overlap multiple chronic disease topics specific to a certain age or gender group. The dataset consists of 1,047,584 rows and 18 columns of information, which must be filtered to present the data efficiently. To make the dataset more manageable and interpretable, I applied a filter to exclude extraneous data, reduced the dataset to two thousand rows, and then isolated specific columns to filter the data further and purify it using the terms Stratification Category 1 combined with Sum Data value and Topic to culminate my results.
The disease data was then categorized into columns to get an overall view of the diseases and the affected population’s location and numbers. After analyzing the data, significant trends were noticed. The data was further cross-referenced with the disease, and an attempt to correlate disease prevalence and geographical area proved unfruitful. The data was then cross-referenced, and it was discovered that COPD appeared more prevalent in women than men. In the analysis, I noted an increase in the association of COPD in women. To investigate this further, I conducted population-based studies to analyze the incidence, prevalence, and risk factors of COPD in women. I also referred to other sources of information to supplement my research hypothesis. Through cross-sectional studies, I compared the prevalence of COPD in women and men and attempted to give geographical significance to my findings. However, my research uncovered no new or relevant information but confirmed already-known data.
In support of my proposed assumption, I cited a CDC article that revealed that the prevalence of COPD was higher among women than men and remained steady from 1998 through 2009. Although this prevalence data was not available from our raw data, it supported my findings in the dataset regarding the increase of COPD in women in the United States. My conclusions were backed up by several enclosed plots comparing the prevalence of COPD in women and men.
Results:
After examining the various columns, trends were seen to be noteworthy. As mentioned earlier, the only observation that stood out was the comparison between males and females regarding their prevalence of COPD. I have attached a table with graphs that illustrate this observation. The data presented in Tables 1-3 indicate that COPD is more prevalent among women than men, even when other risk factors are not considered. The data also suggests that there is a correlation with ethnicity, where non-Hispanic American Indians, Alaska Natives, and non-Hispanic individuals of different races are more likely to have COPD than non-Hispanic White people. Conversely, non-Hispanic Asian, Native Hawaiian, Pacific Islander, and Hispanic individuals have a lower prevalence of COPD than non-Hispanic White people. An attempt was made to establish a geographical connection with COPD, but the data did not support this assumption. Initially, it was thought that the higher prevalence of COPD in non-Hispanic white females was due to geographical factors, such as specific risk factors like smoking or environmental issues. Based on the available data, both men and women are affected by chronic obstructive pulmonary disease (COPD). However, the data needs to provide more information to determine whether this is a new finding or a long-standing issue. We also do not know whether COPD is a new issue or an existing condition aggravated. Additionally, we cannot ascertain whether comorbid illnesses such as asthma or other chronic diseases play a role in the diagnosis of COPD. These findings generated other unanswered questions.
Based on Table 3, the question arises whether gender contributes to the susceptibility to COPD. The data provides some indication that women may be more vulnerable to the disease. Still, there is no clear evidence of whether this is due to gender, lifestyle, environment, or exposure. There are still several unanswered questions, and the available data needs to be more comprehensive to provide a quick answer.
Conclusion:
This secondary research aimed to identify patterns or trends in chronic health indicators (CDI) that could be easily observed through data analysis. The research methodology used was exploratory and secondary to investigate research questions that still need to be studied. In turn, it highlights the importance of developing care strategies that address the specific needs of people affected by Chronic Obstructive Pulmonary Disease (COPD), especially women.
The healthcare industry has a limited understanding of how gender inequality affects healthcare, leading to underdiagnosis and undertreatment of both men and women, depending on the condition. In the past, COPD was thought to act primarily in men, but recent research has shown that it is equally prevalent in both genders.
While the debate on whether gender contributes to the worsening outcomes in COPD development continues, it is essential to consider other risk factors such as smoking, environmental conditions, cultural and socioeconomic characteristics, and ethnicity. Research suggests that female smokers are more likely to develop airflow obstruction than males, and women with COPD in the US experience higher rates of exacerbation and mortality [4]. Unfortunately, healthcare providers sometimes overlook COPD in women, possibly due to a persistent misconception that it is a disease that only affects men [1]. However, COPD presents differently in women and requires specific diagnostic tools and treatment modalities. Healthcare providers must recognize these gender differences and adequately manage this debilitating disease for all patients, or it is much simpler, such as the tools used to diagnose women.
A tool used in diagnosing COPD, the Fletcher and Peto curves have been traditionally used to understand the progression of chronic airflow obstruction in diagnosing Chronic Obstructive Pulmonary Disease (COPD). However, it is crucial to note that this curve was created using data from male patients only and doesn’t reflect the decline in Forced Expiratory Volume (FEV1) in female patients. Despite its limitations, the curve is still used today to plot the rate of FEV1, which measures the air a person can force out of their lungs within one second. If the FEV1 values are lower than average, it could indicate the presence of COPD[2]. For female smokers, research shows that they experience a more significant decline in pulmonary function impairment compared to male smokers who have the same level of tobacco exposure. This makes women more susceptible to developing COPD. Studies also suggest that women have a worse quality of life and experience more severe breathlessness than male smokers with the same level of objective pulmonary compromise[1]. These differences in presentation and disease progression of COPD indicate that it may differ in the female population.
The prevalence of COPD is higher among women, but the exact reason for this is not yet known. While environmental factors may play a role, smoking has a more direct link to disease. A study titled “Improving the Management of COPD in Women” found that even women with minimal tobacco smoke exposure were overrepresented in the subset of patients with severe COPD. The reasons for this susceptibility difference are unclear but could range from genetic predisposition to physical and hormonal variations and exposure to secondhand smoke. These findings highlight the need for further research to determine the significance of these results and, if significant, how we can customize our services to populations with increased susceptibility to this disease. It is essential for medical professionals to recognize the gender differences in the prevalence of COPD and to develop treatments that are tailored to the unique needs of women.

References

1. Akbarshahi H, Ahmadi Z, Currow DC, Sandberg J, Vandersman Z, Shanon-Honson A, Ekström M. No gender-related bias in COPD diagnosis and treatment in Sweden: a randomized, controlled, case-based trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682677/.
2. C Gut-Gobert, A Cavaillès, A Dixmier, S Guillot, S Jouneau, C Leroyer, S Marchand-Adam European Respiratory Review, 2019•Eur Respiratory https://err.ersjournals.com/content/28/151/180055?utm_source=TrendMD&utm_medium=cpc&utm_campaign=European_Respiratory_Review_TrendMD_1.
3. Mini Review article Front. Med., 03 January 2022, Sec. Pulmonary Medicine
   https://doi.org/10.3389/fmed.2021.600107.
4. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health https://www.cdc.gov/copd/index.html#:~:text=COPD%20makes%20breathing%20difficult%20for,COPD%2C%20it%20can%20be%20treated.
5. COPD Mortality and Trendshttps://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-mortality#:~:text=In%202020%2C%20148%2C512%20people%20died,19%2C%20accidents%2C%20and%20stroke.