Chronic Obstructive Pulmonary Disease In Aboriginal Patients Of The Northern Territory Of Australia: A Landscape Perspective

Figures & data

Figure 1 Top End Health Service map, NT, Australia.

Table 1 Demographic Characteristics, Smoking Status, Respiratory Symptoms, And Coexisting Respiratory And Other Medical Conditions In All Patients (Available Data)

Characteristics		Results
Age (years)		57.26±13.21 (n=380)
Gender	Female	212/380 (55.79%)
	Male	168/380 (44.21%)
Weight (kg)		65.81±20.37 (n=282)
BMI (kg/m^2)		24.30±7.01 (n=272)
Smoking status	Current	246/370 (66.49%)
	Past	98/370 (26.49%)
	Never	26/370 (7.03%)
Packs per year		30.54±38.65 (n=176)
Type	Cigarettes	340/367 (92.64%)
	Marijuana	14/367 (3.81%)
	Rollies	18/367 (4.90%)
Deceased	No	342/372 (91.94%)
	Yes	30/372 (8.06%)
Symptoms	Shortness of breath	233/373 (62.47%)
	Productive cough	112/373 (30.03%)
	Wheeze	100/373 (26.81%)
	Cough	86/373 (23.06%)
MRC Dyspnoea Scale	0	87/374 (23.26%)
	1	118/374 (31.55%)
	2	101/374 (27.01%)
	3	59/374 (15.78%)
	4	9/374 (2.41%)
Exacerbations per year		1.18±1.61 (n=374)
Hospital admissions per year		0.87±1.26 (n=372)
Other respiratory conditions	Bronchiectasis	187/374 (49.87%)
	Asthma	122/374 (32.62%)
	Obstructive sleep apnoea	35/374 (9.36%)
	Pulmonary hypertension	14/374 (3.74%)
	Lung cancer	7/374 (1.87%)
	Type 2 respiratory failure	3/374 (0.80%)
Medical comorbidities	Hypertension	68/372 (18.28%)
	Diabetes	56/372 (15.05%)
	Chronic renal failure	49/372 (13.17%)
	Coronary artery disease	40/372 (10.75%)
	Stroke	9/372 (2.42%)

Abbreviation: BMI, body mass index.

Table 2 Relationship Between Smoking Status (Current, Past And Never Smoking History) And Age, BMI, Exacerbations And Hospital Admissions

Results	Overall	Smoking Status			p
		Current	Past	Never
Total	370	66.5	26.5	7.0	p<0.05
Age (years)	57.25±13.21	55.94±11.66	61.74±15.22	54.05±15.96	p<0.05
BMI (kg/m^2)	24.30±7.01	24.15±7.46	24.41±6.13	25.53±6.56	p=0.47
Exacerbations per year	1.18±1.61	1.12±1.38	1.29±2.07	1.38±1.92	p=0.97
Admissions per year	0.87±1.26	0.86±1.17	0.93±1.53	0.85±1.19	p=0.98

Note: Bold text indicates significance.

Abbreviation: BMI, body mass index.

Figure 2 Percentage of deceased (yes, grey bars) and non-deceased (no, white bars) participants in relation to (A) number of exacerbations and (B) number of admissions. The three participants with over six exacerbations and the four participants with over six admissions were excluded from the figure. Numbers on the top of the bars represent number of participants with a given number of exacerbation/admissions.

Figure 3 Treatment details for all patients (available data): short-acting beta-agonists (SABA, n=374), long-acting muscarinic antagonists (LAMA, n=373), long-acting beta-agonists (LABA, n=373), inhaled corticosteroids (ICS, n=372), antibiotic prophylaxis (AP, n=374) and long-term oxygen therapy (LTOT, n=375).

Table 3 Spirometry Values, Sputum Culture, Eosinophil Count, Radiology And Echocardiogram Results In All Patients (Available Data)

Investigations	Parameters	Results
Spirometry results	FEV1 (L)	1.26±0.59 (n=175)
	FEV1 (%)	42.30±18.24 (n=175)
	FVC (L)	2.13±0.72 (n=175)
	FVC (%)	56.35±17.22 (n=175)
	FEV1/FVC<0.7	138/175 (78.86%)
	FEV1/FVC ratio (mean)	0.56±0.17 (n=175)
	Post-bronchodilator values
	FEV1/FVC (mean)	0.57±0.17 (n=156)
	TLC (%)	77.54±26.10 (n=39)
	DLCO (%)	59.33±35.00 (n=38)
Bronchodilator response	No	102/143 (71.33%)
	Yes	41/143 (28.67%)
Chest X-ray findings	COPD and hyperinflated	72/227 (31.58%)
	Normal	58/227 (25.44%)
	COPD and bronchiectasis	49/227 (21.49%)
	Predominant bronchiectasis	26/227 (11.40%)
	COPD and cardiomegaly	9/227 (3.95%)
	COPD and pulmonary infiltrates	5/227 (2.19%)
	Nodules	4/227 (1.75%)
	COPD and interstitial opacity	4/227 (1.75%)
Chest CT scan findings	Bronchiectasis and emphysema	53/139 (38.12%)
	Predominant emphysema	41/139 (29.50%)
	Emphysema and fibrosis	18/139 (12.95%)
	Lung nodules	17/139 (12.23%)
	Normal	10/139 (7.19%)
Cardiac echocardiogram findings	Normal	35/93 (37.63%)
	Valvular anomalies	26/93 (27.96%)
	Pulmonary hypertension	13/93 (13.98%)
	Left ventricle systolic dysfunction	11/93 (11.83%)
	Right ventricle dysfunction	8/93 (8.60%)
Blood count	Eosinophil count	0.29±0.34 (n=187)
Sputum culture results	Oropharyngeal flora	66/160 (41.25%)
	Pseudomonas	21/160 (13.13%)
	Streptococcus pneumoniae	5/160 (3.13%)
	Aspergillus	4/160 (2.50%)
	Haemophilus influenzae	7/160 (2.38%)
	Staphylococcus aureus	3/160 (1.88%)
	NTM	2/160 (1.25%)
	Pseudomonas and H. influenzae	2/160 (1.25%)
	Pseudomonas and NTM	1/160 (0.63%)
	Pseudomonas and Staphylococcus	1/160 (0.63%)
	S. pneumoniae and H. influenzae	1/160 (0.63%)
	Nil	24/160 (15.00%)
	Other	23/160 (14.38%)

Abbreviations: FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; TLC, total lung capacity; DLCO, diffusing capacity of the lungs for carbon monoxide; COPD, chronic obstructive pulmonary disease; NTM, non-tuberculous mycobacterium.

Table 4 Demographic Data, Smoking Status, Symptoms, Exacerbations, Admission Frequency And Investigations Performed, According To Gender (Female and Male)

Results		Overall	Female	Male	Statistics
Gender		380 (100%)	212 (55.8%)	168 (44.2%)	p<0.05
Age (years)		57.3±13.2	56.9±12.6	57.7±14.0	p=0.52
BMI (kg/m^2) (n=271)		24.3±7.0	25.0±7.3	23.3±6.4	p≤0.05
Smoking status (n=370)	Current	66.50%	66.30%	66.70%	p=0.59
	Past	26.50%	25.50%	27.80%
	Never	7%	8.20%	5.60%
Packs per year (n=156)		30.5±38.7	23.4±21.4	39.5±51.8	p<0.05
Symptoms (n=373)	SOB	62.50%	65.70%	58.30%	p=0.14
	Productive cough	30%	30%	30.10%	p=1.00
	Wheeze	26.80%	25.20%	28.80%	p=0.44
	Cough	23.10%	20.50%	26.40%	p=0.18
Exacerbations per year (n=374)		1.2±1.6	1.2±1.4	1.2±1.9	p=0.42
Admissions per year (n=372)		0.9±1.3	0.8±1.1	0.9±1.4	p=0.85
Echocardiogram (n=93)	Valvular anomalies	28%	28.30%	27.70%	p=0.95
	PHT	14%	10.90%	17%	p=0.39
	LV dysfunction	11.80%	4.30%	19.10%	p<0.05
	RHF	8.60%	10.90%	6.40%	p=0.44
	Normal	37.60%	45.70%	29.80%	p=0.11

Note: Bold text indicates significance.

Abbreviations: BMI, body mass index; SOB, shortness of breath; PHT, pulmonary hypertension; LV dysfunction, left ventricle dysfunction; RHF, right heart failure.

Table 5 Demographic Data, Comorbidities And Investigations Performed, According To Spirometry Results

Results		Overall	FEV1/FVC ≥0.7	FEV1/FVC <0.7	Statistics
Total		175	37 (21.1%)	138 (78.9%)	p<0.05
Gender	Female	103 (58.9%)	28 (75.7%)	75 (54.3%)	p<0.05
	Male	72 (41.1%)	9 (24.3%)	63 (45.7%)
Age (years) (n=174)		56.5±11.5	56.1±10.8	56.8±11.7	p=0.81
BMI (kg/m^2) (n=171)		25.9±7.1	28.5±8.7	23.4±6.3	p<0.05
Smoking status (n=173)	Current	59%	67.60%	56.60%	p=0.37
	Past	34.10%	24.30%	36.80%
	Never	6.90%	8.10%	6.60%
Packs per year (n=80)		27.7±24.0	30.6±26.1	24.7±17.2	p=0.55
Comorbidity (n=172)	HTN	14.50%	11.10%	15.40%	p=0.51
	DM	11.60%	8.30%	12.50%	p=0.49
	CRF	9.90%	11.10%	9.60%	p=0.78
	CAD	7.60%	5.60%	8.10%	p=0.61
	Stroke	1.20%	2.80%	0.70%	p=0.31
	Other	49.40%	52.80%	48.50%	p=0.65
Other respiratory conditions (n=175)	Bronchiectasis	49.90%	35.10%	55.10%	p<0.05
	Asthma	36.60%	45.90%	34.10%	p=0.18
	OSA	10.30%	5.40%	11.60%	p=0.27
	PHT	4%	2.70%	4.30%	p=0.65
	Lung cancer	2.30%	2.70%	2.20%	p=0.85
	ChT2RF	1.10%	0%	1.40%	p=0.46
Echocardiogram (n=46)	Valvular anomalies	26.10%	6.50%	19.60%	p=0.58
	PHT	10.90%	2.20%	8.70%	p=0.98
	RHF	10.90%	2.20%	8.70%	p=0.98
	LV failure	8.70%	0%	8.70%	p=0.30
	Normal	43.50%	8.70%	34.80%	p=0.95

Note: Bold text indicates significance.

Abbreviations: BMI, body mass index; HTN, hypertension; DM, diabetes mellitus; CRF, chronic renal failure; CAD, coronary artery disease; OSA, obstructive sleep apnoea; PHT, pulmonary hypertension; ChT2RF, chronic type 2 respiratory failure; RHF, right heart failure; LV failure, left ventricular failure.

Table 6 Indigenous Target Communities' Demographic, Clinical And Fire Frequency Data

Community	Number Of People (range)	Gender Ratio (Females /Males)	Average					Percentage (Number Of People) %
			Age (years)	BMI (kg/m^2)	Fire Frequency	Exacerbations Per Patient	Admissions Per Patient	Aboriginal (Range)	FEV1/FVC <0.7	Asthma	Bronchiectasis
1	850–900	1.1	60.4	22.8	2.6	1.3	0.6	95–100	0.8	0.1	0.5
2	850–900	0.9	61.1	27.7	6.9	1.2	1.1	75–80	0.8	0.2	0.9
3	2200–2250	1.0	48.6	28.9	1.6	1.0	0.4	90–95	0.2	0.1	0.2
4	2300–2350	0.9	53.1	22.4	1.1	0.6	0.4	85–90	0.5	0.4	0.8
5	400–450	1.0	58.3	24.3	1.0	1.0	0.8	90−95	1.0	0.0	0.7
6	200–250	1.1	61.4	26.9	1.7	0.8	0.7	90−95	1.2	2.4	2.4
7	1550–1600	1.0	54.8	24.7	2.7	1.7	1.0	90–95	0.7	0.3	0.9
8	1100–1150	1.0	55.2	27.3	5.7	0.8	0.6	90–95	0.7	1.0	0.3
9	1100–1150	1.1	48.5	22.0	6.5	0.6	0.6	85–90	0.1	0.4	0.4
10	850–900	1.1	53.5	19.3	8.3	0.9	0.4	90–95	0.9	0.6	0.9
11	500–550	1.0	54.5	22.8	0.2	1.1	0.9	95–100	1.8	1.8	1.8
12	2250–2300	1.1	58.2	23.3	6.2	0.5	0.4	85–90	0.2	0.4	0.6

Abbreviations: BMI, body mass index; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity.

Table 7 Stepwise Multiple Regression Results For The 12 Small Indigenous Target Communities' Demography With Regard To The Effects Of Age, BMI, Percentage Of Smokers, Past Smokers/Current Smokers Ratio And Fire Frequency On COPD

Statistics	Multiple Regression	Age (Average)		BMI (Average)		Smokers (%) Current And Past		Past Smokers/Current Smokers		Fire Frequency (Average)		Overall Regression Statistics
	AIC	F	p	F	p	F	p	F	p	F	p
Spirometry results FEV1/FVC <0.7	−144.2	0.38	0.55	0.77	0.40	9.37	<0.05	0.28	0.61	1.47	0.25	R^2=0.46, F1,11=9.37, p<0.05
Bronchiectasis (%)	−34.25	2.79	0.13	3.14	0.11	0.05	0.83	0.43	0.53	0.73	0.42	R^2=0.75, F1,11=3.65, p=0.07
Asthma (%)	−148.45	6.57	<0.05	0.00	0.82	54.94	<0.05	0.10	0.76	0.05	0.82	R^2=0.86, F2,10=29.56, p<0.05
Number of exacerbations (average)	−27.15	0.48	0.51	0.25	0.63	0.26	0.62	4.29	0.07	5.73	<0.05	R^2=0.48, F1,11=4.60, p<0.05
Number of admissions (average)	−33.99	4.05	0.07	0.39	0.55	0.10	0.76	0.01	0.93	1.50	0.25	R^2=0.27, F1,11=4.05, p=0.07

Note: Bold text indicates significance.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; AIC, Akaike Information Criterion; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity.