Unemployment in chronic airflow obstruction around the world: results from the BOLD study

doi:10.1183/13993003.00499-2017

Multicenter Study

. 2017 Sep 20;50(3):1700499.

doi: 10.1183/13993003.00499-2017. Print 2017 Sep.

Unemployment in chronic airflow obstruction around the world: results from the BOLD study

Collaborators, Affiliations

Collaborators

Research teams at centres:
NanShan Zhong, Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jingping Zheng, Yumin Zhou, Ali Kocabaş, Attila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, Turgay Unalan, Michael Studnicka, Torkil Dawes, Bernd Lamprecht, Lea Schirhofer, Eric Bateman, Anamika Jithoo, Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, Janita Storbeck, Thorarinn Gislason, Bryndis Benedikdtsdottir, Kristin Jörundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, Gunnar Gundmundsson, Ewa Nizankowska-Mogilnicka, Jakub Frey, Rafal Harat, Filip Mejza, Pawel Nastalek, Andrzej Pajak, Wojciech Skucha, Andrzej Szczeklik, Magda Twardowska, Tobias Welte, Isabelle Bodemann, Henning Geldmacher, Alexandra Schweda-Linow, Amund Gulsvik, Tina Endresen, Lene Svendsen, Wan C Tan, Wen Wang, David M Mannino, John Cain, Rebecca Copeland, Dana Hazen, Jennifer Methvin, Renato B Dantes, Lourdes Amarillo, Lakan U Berratio, Lenora C Fernandez, Norberto A Francisco, Gerard S Garcia, Teresita S de Guia, Luisito F Idolor, Sullian S Naval, Thessa Reyes, Camilo C Roa Jr, Ma Flordeliza Sanchez, Leander P Simpao, Christine Jenkins, Guy Marks, Tessa Bird, Paola Espinel, Kate Hardaker, Brett Toelle, Peter G J Burney, Caron Amor, James Potts, Michael Tumilty, Fiona McLean, E F M Wouters, G J Wesseling, Cristina Bárbara, Fátima Rodrigues, Hermínia Dias, João Cardoso, João Almeida, Maria João Matos, Paula Simão, Moutinho Santos, Reis Ferreira, Christer Janson, Inga Sif Olafsdottir, Katarina Nisser, Ulrike Spetz-Nyström, Gunilla Hägg, Gun-Marie Lund, Rain Jõgi, Hendrik Laja, Katrin Ulst, Vappu Zobel, Toomas-Julius Lill, Parvaiz A Koul, Sajjad Malik, Nissar A Hakim, Umar Hafiz Khan, Rohini Chowgule, Vasant Shetye, Jonelle Raphael, Rosel Almeda, Mahesh Tawde, Rafiq Tadvi, Sunil Katkar, Milind Kadam, Rupesh Dhanawade, Umesh Ghurup, Imed Harrabi, Myriam Denguezli, Zouhair Tabka, Hager Daldoul, Zaki Boukheroufa, Firas Chouikha, Wahbi Belhaj Khalifa, Luisito F Idolor, Teresita S de Guia, Norberto A Francisco, Camilo C Roa, Fernando G Ayuyao, Cecil Z Tady, Daniel T Tan, Sylvia Banal-Yang, Vincent M Balanag Jr, Maria Teresita N Reyes, Renato B Dantes, Sanjay Juvekar, Siddhi Hirve, Somnath Sambhudas, Bharat Chaidhary, Meera Tambe, Savita Pingale, Arati Umap, Archana Umap, Nitin Shelar, Sampada Devchakke, Sharda Chaudhary, Suvarna Bondre, Savita Walke, Ashleshsa Gawhane, Anil Sapkal, Rupali Argade, Vijay Gaikwad, Sundeep Salvi, Bill Brashier, Jyoti Londhe, Sapna Madas, Mohamed C Benjelloun, Chakib Nejjari, Mohamed Elbiaze, Karima El Rhazi, Daniel Obaseki, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Mohamed Al Ghobain, Hassan Alorainy, Esam El-Hamad, Mohamed Al Hajjaj, Hashi Ayan, Rowena Dela, Rofel Fanuncio, Elizabeth Doloriel, Imelda Marciano, Lyla Safia, Talant M Sooronbaev, Bermet M Estebesova, Meerim Akmatalieva, Saadat Usenbaeva, Jypara Kydyrova, Eliza Bostonova, Ulan Sheraliev, Nuridin Marajapov, Nurgul Toktogulova, Berik Emilov, Toktogul Azilova, Gulnara Beishekeeva, Nasyikat Dononbaeva, Aijamal Tabyshova, Kevin Mortimer, Wezzie Nyapigoti, Ernest Mwangoka, Mayamiko Kambwili, Martha Chipeta, Gloria Banda, Suzgo Mkandawire, Justice Banda, Asma Elsony, Hana A Elsadig, Nada Bakery Osman, Bandar Salah Noory, Monjda Awad Mohamed, Hasab Alrasoul Akasha Ahmed Osman, Namarig Moham Ed Elhassan, Abdel Muis El Zain, Marwa Mohamed Mohamaden, Suhaiba Khalifa, Mahmoud Elhadi, Mohand Hassan, Dalia Abdelmonam, Hasan Hafizi, Anila Aliko, Donika Bardhi, Holta Tafa, Natasha Thanasi, Arian Mezini, Alma Teferici, Dafina Todri, Jolanda Nikolla, Rezarta Kazasi, Hamid Hacene Cherkaski, Amira Bengrait, Tabarek Haddad, Ibtissem Zgaoula, Maamar Ghit, Abdelhamid Roubhia, Soumaya Boudra, Feryal Atoui, Randa Yakoubi, Rachid Benali, Abdelghani Bencheikh, Nadia Ait-Khaled, Akramul Islam, Syed Masud Ahmed, Shayla Islam, Qazi Shafayetul Islam, Mesbah Ul-Haque, Tridib Roy Chowdhury, Sukantha Kumar Chatterjee, Dulal Mia, Shyamal Chandra Das, Mizanur Rahman, Nazrul Islam, Shahaz Uddin, Nurul Islam, Luiza Khatun, Monira Parvin, Abdul Awal Khan, Maidul Islam, Li-Cher Loh, Abdul Rashid, Siti Sholehah, Herve Lawin, Arsene Kpangon, Karl Kpossou, Gildas Agodokpessi, Paul Ayelo, Benjamin Fayomi

Affiliations

¹ Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
² Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway marta.erdal@k2.uib.no.
³ Dept of Clinical Science, University of Bergen, Bergen, Norway.
⁴ UBC James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada.
⁵ Dept of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria.
⁶ National Heart and Lung Institute, Imperial College London, London, UK.
⁷ Dept of Respiratory Medicine and Sleep, Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland.
⁸ Vadu Health and Demographic Surveillance System, KEM Hospital Research Centre Pune, Pune, India.
⁹ Dept of Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar, India.
¹⁰ Dept of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
¹¹ Chest Research Foundation, Chest Research Foundation, Pune, India.
¹² Pulmonary and Critical Care Medicine, UHN67, Oregon Health and Science University, Portland, OR, USA.
¹³ Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹⁴ Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

PMID: 28931661
PMCID: PMC5898950
DOI: 10.1183/13993003.00499-2017

Multicenter Study

Unemployment in chronic airflow obstruction around the world: results from the BOLD study

Rune Grønseth et al. Eur Respir J. 2017.

. 2017 Sep 20;50(3):1700499.

doi: 10.1183/13993003.00499-2017. Print 2017 Sep.

Authors

Collaborators

Research teams at centres:
NanShan Zhong, Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jingping Zheng, Yumin Zhou, Ali Kocabaş, Attila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, Turgay Unalan, Michael Studnicka, Torkil Dawes, Bernd Lamprecht, Lea Schirhofer, Eric Bateman, Anamika Jithoo, Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, Janita Storbeck, Thorarinn Gislason, Bryndis Benedikdtsdottir, Kristin Jörundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, Gunnar Gundmundsson, Ewa Nizankowska-Mogilnicka, Jakub Frey, Rafal Harat, Filip Mejza, Pawel Nastalek, Andrzej Pajak, Wojciech Skucha, Andrzej Szczeklik, Magda Twardowska, Tobias Welte, Isabelle Bodemann, Henning Geldmacher, Alexandra Schweda-Linow, Amund Gulsvik, Tina Endresen, Lene Svendsen, Wan C Tan, Wen Wang, David M Mannino, John Cain, Rebecca Copeland, Dana Hazen, Jennifer Methvin, Renato B Dantes, Lourdes Amarillo, Lakan U Berratio, Lenora C Fernandez, Norberto A Francisco, Gerard S Garcia, Teresita S de Guia, Luisito F Idolor, Sullian S Naval, Thessa Reyes, Camilo C Roa Jr, Ma Flordeliza Sanchez, Leander P Simpao, Christine Jenkins, Guy Marks, Tessa Bird, Paola Espinel, Kate Hardaker, Brett Toelle, Peter G J Burney, Caron Amor, James Potts, Michael Tumilty, Fiona McLean, E F M Wouters, G J Wesseling, Cristina Bárbara, Fátima Rodrigues, Hermínia Dias, João Cardoso, João Almeida, Maria João Matos, Paula Simão, Moutinho Santos, Reis Ferreira, Christer Janson, Inga Sif Olafsdottir, Katarina Nisser, Ulrike Spetz-Nyström, Gunilla Hägg, Gun-Marie Lund, Rain Jõgi, Hendrik Laja, Katrin Ulst, Vappu Zobel, Toomas-Julius Lill, Parvaiz A Koul, Sajjad Malik, Nissar A Hakim, Umar Hafiz Khan, Rohini Chowgule, Vasant Shetye, Jonelle Raphael, Rosel Almeda, Mahesh Tawde, Rafiq Tadvi, Sunil Katkar, Milind Kadam, Rupesh Dhanawade, Umesh Ghurup, Imed Harrabi, Myriam Denguezli, Zouhair Tabka, Hager Daldoul, Zaki Boukheroufa, Firas Chouikha, Wahbi Belhaj Khalifa, Luisito F Idolor, Teresita S de Guia, Norberto A Francisco, Camilo C Roa, Fernando G Ayuyao, Cecil Z Tady, Daniel T Tan, Sylvia Banal-Yang, Vincent M Balanag Jr, Maria Teresita N Reyes, Renato B Dantes, Sanjay Juvekar, Siddhi Hirve, Somnath Sambhudas, Bharat Chaidhary, Meera Tambe, Savita Pingale, Arati Umap, Archana Umap, Nitin Shelar, Sampada Devchakke, Sharda Chaudhary, Suvarna Bondre, Savita Walke, Ashleshsa Gawhane, Anil Sapkal, Rupali Argade, Vijay Gaikwad, Sundeep Salvi, Bill Brashier, Jyoti Londhe, Sapna Madas, Mohamed C Benjelloun, Chakib Nejjari, Mohamed Elbiaze, Karima El Rhazi, Daniel Obaseki, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Mohamed Al Ghobain, Hassan Alorainy, Esam El-Hamad, Mohamed Al Hajjaj, Hashi Ayan, Rowena Dela, Rofel Fanuncio, Elizabeth Doloriel, Imelda Marciano, Lyla Safia, Talant M Sooronbaev, Bermet M Estebesova, Meerim Akmatalieva, Saadat Usenbaeva, Jypara Kydyrova, Eliza Bostonova, Ulan Sheraliev, Nuridin Marajapov, Nurgul Toktogulova, Berik Emilov, Toktogul Azilova, Gulnara Beishekeeva, Nasyikat Dononbaeva, Aijamal Tabyshova, Kevin Mortimer, Wezzie Nyapigoti, Ernest Mwangoka, Mayamiko Kambwili, Martha Chipeta, Gloria Banda, Suzgo Mkandawire, Justice Banda, Asma Elsony, Hana A Elsadig, Nada Bakery Osman, Bandar Salah Noory, Monjda Awad Mohamed, Hasab Alrasoul Akasha Ahmed Osman, Namarig Moham Ed Elhassan, Abdel Muis El Zain, Marwa Mohamed Mohamaden, Suhaiba Khalifa, Mahmoud Elhadi, Mohand Hassan, Dalia Abdelmonam, Hasan Hafizi, Anila Aliko, Donika Bardhi, Holta Tafa, Natasha Thanasi, Arian Mezini, Alma Teferici, Dafina Todri, Jolanda Nikolla, Rezarta Kazasi, Hamid Hacene Cherkaski, Amira Bengrait, Tabarek Haddad, Ibtissem Zgaoula, Maamar Ghit, Abdelhamid Roubhia, Soumaya Boudra, Feryal Atoui, Randa Yakoubi, Rachid Benali, Abdelghani Bencheikh, Nadia Ait-Khaled, Akramul Islam, Syed Masud Ahmed, Shayla Islam, Qazi Shafayetul Islam, Mesbah Ul-Haque, Tridib Roy Chowdhury, Sukantha Kumar Chatterjee, Dulal Mia, Shyamal Chandra Das, Mizanur Rahman, Nazrul Islam, Shahaz Uddin, Nurul Islam, Luiza Khatun, Monira Parvin, Abdul Awal Khan, Maidul Islam, Li-Cher Loh, Abdul Rashid, Siti Sholehah, Herve Lawin, Arsene Kpangon, Karl Kpossou, Gildas Agodokpessi, Paul Ayelo, Benjamin Fayomi

Affiliations

¹ Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
² Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway marta.erdal@k2.uib.no.
³ Dept of Clinical Science, University of Bergen, Bergen, Norway.
⁴ UBC James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada.
⁵ Dept of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria.
⁶ National Heart and Lung Institute, Imperial College London, London, UK.
⁷ Dept of Respiratory Medicine and Sleep, Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland.
⁸ Vadu Health and Demographic Surveillance System, KEM Hospital Research Centre Pune, Pune, India.
⁹ Dept of Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar, India.
¹⁰ Dept of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
¹¹ Chest Research Foundation, Chest Research Foundation, Pune, India.
¹² Pulmonary and Critical Care Medicine, UHN67, Oregon Health and Science University, Portland, OR, USA.
¹³ Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹⁴ Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

PMID: 28931661
PMCID: PMC5898950
DOI: 10.1183/13993003.00499-2017

Abstract

We aimed to examine associations between chronic airflow obstruction (CAO) and unemployment across the world.Cross-sectional data from 26 sites in the Burden of Obstructive Lung Disease (BOLD) study were used to analyse effects of CAO on unemployment. Odds ratios for unemployment in subjects aged 40-65 years were estimated using a multilevel mixed-effects generalised linear model with study site as random effect. Site-by-site heterogeneity was assessed using individual participant data meta-analyses.Out of 18 710 participants, 11.3% had CAO. The ratio of unemployed subjects with CAO divided by subjects without CAO showed large site discrepancies, although these were no longer significant after adjusting for age, sex, smoking and education. The site-adjusted odds ratio (95% CI) for unemployment was 1.79 (1.41-2.27) for CAO cases, decreasing to 1.43 (1.14-1.79) after adjusting for sociodemographic factors, comorbidities and forced vital capacity. Of other covariates that were associated with unemployment, age and education were important risk factors in high-income sites (4.02 (3.53-4.57) and 3.86 (2.80-5.30), respectively), while female sex was important in low- to middle-income sites (3.23 (2.66-3.91)).In the global BOLD study, CAO was associated with increased levels of unemployment, even after adjusting for sociodemographic factors, comorbidities and lung function.

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Conflict of interest statement

Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

Figures

**FIGURE 1**
Distribution of job status by sex for participants in a) high-, and b) low- to middle-income countries. n=18 710.

**FIGURE 2**
Odds ratios (95% CI) for unemployment for lower limit of normal-defined chronic airflow obstruction, adjusted for demographic characteristics, comorbidities and forced vital capacity (FVC). Adjustment variables: sex, age, smoking, education, hypertension, heart disease, diabetes, stroke, lung cancer and FVC. n=11 675, meta-analysis with results across sites and overall. Retirees (age limit defined as 65 years) and homemakers/caregivers excluded. BOLD: Burden of Obstructive Lung Disease study.

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Comment in

Can epidemiological studies determine the productivity-related burden of COPD?
Stanojevic S. Stanojevic S. Eur Respir J. 2017 Sep 20;50(3):1701515. doi: 10.1183/13993003.01515-2017. Print 2017 Sep. Eur Respir J. 2017. PMID: 28931671 No abstract available.

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References

1. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007; 370: 741–750. - PubMed
1. The World Health Organization (WHO) Projections of Mortality and Causes of Death, 2015 and 2030. www.who.int/healthinfo/global_burden_disease/projections/en/ Date last accessed: June 16, 2017. Date last updated: 2013.
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1. Grønseth R, Jansson SA. The economic burden of respiratory diseases: COPD and asthma In: Annesi-Maesano I, Lundbäck B, Viegi G, eds. Respiratory Epidemiology. Eur Respir Monogr 2014; 65: 116–124.
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[1] Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007; 370: 741–750. - PubMed

[2] Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007; 370: 741–750. - PubMed

[3] The World Health Organization (WHO) Projections of Mortality and Causes of Death, 2015 and 2030. www.who.int/healthinfo/global_burden_disease/projections/en/ Date last accessed: June 16, 2017. Date last updated: 2013.

[4] The World Health Organization (WHO) Projections of Mortality and Causes of Death, 2015 and 2030. www.who.int/healthinfo/global_burden_disease/projections/en/ Date last accessed: June 16, 2017. Date last updated: 2013.

[5] Janson C, Marks G, Buist S, et al. The impact of COPD on health status: findings from the BOLD study. Eur Respir J 2013; 42: 1472–1483. - PMC - PubMed

[6] Janson C, Marks G, Buist S, et al. The impact of COPD on health status: findings from the BOLD study. Eur Respir J 2013; 42: 1472–1483. - PMC - PubMed

[7] Grønseth R, Jansson SA. The economic burden of respiratory diseases: COPD and asthma In: Annesi-Maesano I, Lundbäck B, Viegi G, eds. Respiratory Epidemiology. Eur Respir Monogr 2014; 65: 116–124.

[8] Grønseth R, Jansson SA. The economic burden of respiratory diseases: COPD and asthma In: Annesi-Maesano I, Lundbäck B, Viegi G, eds. Respiratory Epidemiology. Eur Respir Monogr 2014; 65: 116–124.

[9] Erdal M, Johannessen A, Askildsen JE, et al. Productivity losses in chronic obstructive pulmonary disease: a population-based survey. BMJ Open Respir Res 2014; 1: e000049. - PMC - PubMed

[10] Erdal M, Johannessen A, Askildsen JE, et al. Productivity losses in chronic obstructive pulmonary disease: a population-based survey. BMJ Open Respir Res 2014; 1: e000049. - PMC - PubMed

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Unemployment in chronic airflow obstruction around the world: results from the BOLD study

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Unemployment in chronic airflow obstruction around the world: results from the BOLD study

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