MLHU - Health Status Resource

Respiratory disease

Respiratory disease
Key Findings: 

Chronic respiratory diseases affect the airways and other parts of the lungs. Some examples of chronic respiratory diseases include (but are not limited to): asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer, and sleep apnea.1 Respiratory diseases are chronic diseases of public health importance in which Ontario public health units have a mandate to reduce their burden through interventions that promote health and help to prevent disease.2 In Middlesex-London, hospitalization rates for respiratory disease increased over time from 2006 to 2018. Rates of emergency department (ED) visits for respiratory disease were highest for the youngest (≤19) and oldest (75+) age groups; with high rates for asthma for the ≤19 age group and chronic obstructive pulmonary disease (COPD) for the 75+ age group. As tobacco smoke and indoor/outdoor air quality are two key risk factors for respiratory disease1, public health measures can help to reduce exposure to these risk factors and ultimately reduce the burden of respiratory diseases.

Respiratory disease Asthma
Lower respiratory tract disease Chronic obstructive pulmonary disease 

Respiratory disease

Rates of ED visits for respiratory disease increased in Middlesex-London from 2015 to 2018 (Figure 7.4.1). Rates in Middlesex-London were significantly higher compared to Ontario in 2017 and 2018.

In Middlesex-London, rates of ED visits for respiratory disease were highest among under the age of 20 (8797.4 per 100,000), followed by those age 75 and older (7326.0 per 100,000) in 2018 (Figure 7.4.2). In contrast, hospitalization rates for respiratory disease were highest among those age 75 and older (3,388.4 per 100,000), followed by those age 65 to 74 (1,451.9 per 100,000) (Figure 7.4.4).

Hospitalization rates for respiratory disease increased over time in Middlesex-London from 2006 to 2018 (Figure 7.4.3). Rates in Middlesex-London were not significantly different compared to Ontario from 2010 to 2018.

Rates of ED visits (not shown) and hospitalizations (Figure 7.4.5) for respiratory disease were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017.

Hospitalization rates for respiratory disease in Middlesex-London were significantly higher among males compared in females from 2006 to 2018 (Figure 7.4.6).

Death rates from respiratory disease were higher in Middlesex-London compared to Ontario from 2012 to 2015, however the differences were not statistically significant (Figure 7.4.7).

In Middlesex-London, death rates from respiratory disease in 2015 increased with age and was significantly higher among those age 75 years and older (798.5 per 100,000) (Figure 7.4.8).

Interpretation

Chronic respiratory disease is an umbrella term for diseases affect the airways and other parts of the lungs. Some types of chronic respiratory disease include (but are not limited to): asthma, lung cancer, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and sleep apnea. They can affect people of all ages. Two key risk factors for chronic respiratory diseases are tobacco smoke and indoor/outdoor air quality.1

Lower respiratory tract disease

Lower respiratory tract diseases include chronic obstructive pulmonary disease (COPD) and asthma. Rates of ED visits for lower respiratory tract disease in Middlesex-London decreased over time from 2006 to 2013, but then increased from 2013 to 2018 (Figure 7.4.9). Rates were significantly lower in Middlesex-London compared to Ontario from 2006 to 2018.

Rates of ED visits and hospitalization for lower respiratory tract disease were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017 (not shown).

When comparing across age groups, rates of ED visits (Figure 7.4.10) and hospitalizations (not shown) in Middlesex-London in 2018 followed a pattern similar to a checkmark shape. That is, the rate was higher among those age 19 and younger (789.0 per 100,000), declined to its lowest rate among those age 20 to 44 (314.8 per 100,000), and then slowly increased with age, reaching its highest level in the oldest age group (age 75 and older; 2,148.3 per 100,000). In contrast, death rates in Middlesex-London from lower respiratory tract disease in 2015 increased with age and was significantly higher among those age 75 years and older (323.5 per 100,000) (Figure 7.4.14).

Hospitalization rates for lower respiratory tract disease were lower in Middlesex-London compared to Ontario from 2006 to 2017, but then edged slightly higher in 2018 (214.9 vs. 211.4 per 100,000) (Figure 7.4.11).

Rates of ED visits for lower respiratory tract disease were not significantly different between females and males in Middlesex-London from 2006 to 2018 (not shown). However, hospitalization rates were generally higher among males compared to females during this period (Figure 7.4.12).

Overall, rates of death due to lower respiratory tract disease in Middlesex-London were not significantly different compared to Ontario from 2006 to 2015 (Figure 7.4.13).

The Leading Causes of Death section contains data showing that lower respiratory tract diseases were the fifth leading cause of death in Middlesex-London from 2013 to 2015.

Interpretation

Lower respiratory tract disease involve the windpipe (trachea), bronchial tubes, or lungs.3 It is an umbrella term that consists of chronic obstructive pulmonary tract disease (COPD) (including: chronic bronchitis and emphysema) and asthma.4 Lower respiratory tract disease can affect people of all ages. The two main risk factors are exposure to tobacco smoke and poor air quality.1

Asthma

Among the Middlesex-London population age 12 years and older, 8.2% reported having asthma in 2015/16 (Figure 7.4.15). The percent was lower compared to Ontario (8.8%) and the Peer Group (8.7%), but the difference was not statistically significant.

Rates of ED visits for asthma increased over time in Middlesex-London from 2013 to 2018, following a decline from 2006 to 2013 (Figure 7.4.16). The Middlesex-London rate for 2018 (305.7 per 100,000) was significantly higher compared to Ontario (286.5 per 100,000).

Overall, rates of ED visits and hospitalizations did not differ significantly between females and males in Middlesex-London from 2006 to 2018.

When comparing across age groups, rates of ED visits for asthma in Middlesex-London in 2018 were highest among those under the age of 20 (758.3 per 100,000) and generally decreased with age (Figure 7.4.17). In contrast, hospitalization rates across age groups were u-shaped; where rates were highest among the youngest (age ≤19, 96.1 per 100,000) and oldest age groups (age 75+, 95.2 per 100,000), and lowest among the age groups in the middle (Figure 7.4.19).

Hospitalization rates for asthma increased over time in Middlesex-London from 2015 to 2018 (Figure 7.4.18). The rate in Middlesex-London (38.6 per 100,000) was higher compared to Ontario (35.6 per 100,000) in 2018, but the difference was not statistically significant.

Death rates from asthma were low in Middlesex-London, Ontario and the Peer Group from 2006 to 2015, but the differences were not generally statistically significant (Figure 7.4.20).

Interpretation

Asthma is a chronic disease that causes the lining of airways to become inflamed, causing the airways to narrow and making it difficult for air to pass through.5, 6 Symptoms of asthma include: coughing, shortness of breath, chest tightness, and wheezing.5 Asthma symptoms and attacks can be triggered by tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, physical activity, respiratory infections and other exposures.7 While there is no cure for asthma, it can be managed by avoiding triggers and controlling symptoms once they occur.8

Chronic obstructive pulmonary disease

Rates of ED visits for chronic obstructive pulmonary disease (COPD) were significantly lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.4.21).

Rates of ED visits (Figure 7.4.22) and hospitalizations (not shown) for COPD were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017.

While rates of ED visits for COPD did not differ significantly between females and males in Middlesex-London from 2006 to 2018, hospitalization rates for COPD were generally significantly higher among males compared to females (not shown).

Overall, hospitalization rates for COPD were generally lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.4.23). In 2018, the rate in Middlesex-London (173.1 per 100,000) was slightly higher compared to Ontario (172.9 per 100,000), but the difference was not statistically significant.

When comparing across age groups in Middlesex-London in 2018, the rate of ED visits (not shown) and hospitalizations (Figure 7.4.24) for COPD increased with age and were highest among those age 75 years and older.

Death rates due to COPD were relatively stable in Middlesex-London from 2006 to 2015, and were not significantly different compared to Ontario (Figure 7.4.25).

Death rates increased significantly with age and were highest among those age 75 years and older (320.6 per 100,000; not shown).

Death rates due to COPD were higher among males compared to females in Middlesex-London from 2006 to 2015 (Figure 7.4.26). Differences in rates were not statistically significant in the three most recent years for which data are available (2013 to 2015).

Interpretation

Chronic Obstructive Pulmonary Disease (COPD) is a lower respiratory tract disease that slowly damages the airways of the lungs, causing limitations in airflow and making it hard to breathe. It is a disease that gets progressively worse over time. COPD is an umbrella term that includes a number of lung diseases such as chronic bronchitis and emphysema; many people with COPD have both of these diseases.9

Approximately 9 out of 10 cases of COPD are caused by smoking tobacco cigarettes. Other risk factors for COPD include: genetics, exposure to second-hand smoke, exposure to air pollution, and a history of childhood lung infections.9

There is no cure for COPD, but the disease can be managed.

Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability
Population Health Assessment and Surveillance Protocol, 2018
Chronic Disease Prevention Guideline, 2018

References:

1. Public Health Agency of Canada. Chronic Respiratory Diseases [Internet]. Ottawa, ON: Government of Canada; 2014 [cited 2019 Sep 23]. Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/chronic...

2. Ministry of Health and Long-Term Care. Ontario Public Health Standards: Requirements for Programs, Services, and Accountability [Internet]. Toronto, ON: Queen's Printer for Ontario, 2018 [cited 2019 Jul 30]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d...

3. Healthwise Staff. Respiratory System [Internet]. Edmonton, AB: Government of Alberta; 2018 [cited 2019 Sep 26]. Available from: https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=ug2841

4. Oelsner EC, Loehr LR, Henderson AG, Donohue KM, Enright PL, Kalhan R, et al. Classifying Chronic Lower Respiratory Disease Events in Epidemiologic Cohort Studies. Ann Am Thorac Soc [Internet]. 2016 [cited 2019 Sep 26];13(7):1057–66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27088163 DOI: 10.1513/AnnalsATS.201601-063OC

5. Public Health Agency of Canada. Asthma [Internet]. Ottawa, ON: Government of Canada; [cited 2019 Sep 23]. Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/chronic...
6. Canadian Lung Association. Asthma [Internet]. Ottawa, ON: Canadian Lung Association; 2019 [cited 2019 Sep 23]. Available from: https://www.lung.ca/asthma

7. Centers for Disease Control and Prevention. Common Asthma Triggers [Internet]. Atlanta, GA: U.S. Department of Health & Human Services; 2010 [cited 2019 Sep 23]. Available from: https://www.cdc.gov/asthma/triggers.html

8. Public Health Agency of Canada. Can I Manage My Asthma? [Internet]. Ottawa, ON: Government of Canada; 2008 [cited 2019 Sep 23]. Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/chronic...

9. Public Health Agency of Canada. What Is COPD and Can It Be Prevented? [Internet]. Ottawa, ON: Government of Canada; 2008 [cited 2019 Sep 23]. Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/chronic...

Last modified on: November 18, 2019