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WHO-ILAR COPCORD Pilot Study in Tehran, Iran To the Editor: COPCORD (Community Oriented Program for Control Of Rheumatic Diseases) was created for the recognition, prevention, and control of rheumatic disorders. A small-scale COPCORD study was performed in a rural community in Iran in 19931. The study was conducted on 2502 persons in Fasham district of Shemiranat (the northern suburb of Tehran). The population is Caucasian. Iran is a country with different ethnic groups: Caucasians, Turks, and Semites2. It was therefore necessary to have a new COPCORD study taking into account all the ethnic populations of Iran. A pilot study was designed by the Rheumatology Research Center at Tehran University for Medical Sciences, to test the feasibility of a large-scale project. Five districts (north, south, east, west, and the center) were selected randomly in Tehran. The population of Tehran reflects the ethnic distribution of Iran (Caucasians 75.4%, Turks 22%, Semites 2.6%). The 5 clusters in the 5 districts were the Namjoo, Esma'il-Abad, Jahan Ara, Niroo-Hava'I, and Tehransar. With the help of the Iranian Post Office organization, houses were selected randomly for interviews. The average population per household (aged 15 yrs and over) is 2.7 persons in Tehran (Iran population census 1996). Interviewers were selected from Bachelor of Science certified nurses or nurse-midwives. They were trained by interviewing 20 subjects. The observed agreement was 0.96. The chance-expected agreement was 0.53. The kappa coefficient was 0.92 (standard error 0.11). The z status was 8.19. The one-tailed p value was < 0.0001. Laboratory technicians were briefed one week before the pilot study. Rheumatologists were selected from among the rheumatology subspecialty fellows, and were briefed accordingly. Five team supervisors were selected from 28 candidates and trained. The original COPCORD questionnaire was translated from English to Farsi by a rheumatologist not working for the project. The Farsi version was then back-translated by another rheumatologist, unaware of the original version. The 2 versions did not differ significantly. The pilot study started on October 3, 2003, and 5 interview teams participated. Each team consisted of a supervisor, 3 interviewers, one rheumatologist, one laboratory technician, and 2 drivers (2 cars). Teams were supervised by the administrative director (A. Tehrani) under the supervision of the project directors (F. Davatchi and A.R. Jamshidi). All data were entered into a computer. Five percent of interviews were subjected to quality control, and errors were found in less than 1% of these. One hundred sixty-eight houses were visited. The completed interviews totalled 284 (response rate 60%). Subjects' ages ranged from 15 to 82.5 years; mean age was 39.2 (standard deviation 17.4). The male to female ratio was 0.87 to 1. The ethnic distribution was Caucasians 66.2%, Turks 32%, and Semites 1.8%. One hundred twenty-nine patients (45.4%, 95% CI 5.8) complained of musculoskeletal disorders (MSD) during the past week. Among them, 26.5% had a recent antecedent of trauma. Abstracting data for traumatic complaints, the percentage of rheumatic complaints became 34.5%. The distribution was shoulder 18.3%, wrist 13.4%, hand 15.1%, hip 10.2%, knee 26.1%, ankle 12.7%, great toe 11.6%, cervical spine 13.7%, dorsal and lumbar spine 22.2%, and other 12.3%. Past complaint of MSD was 21.1% (95% CI 4.7). The distribution was shoulder 9%, wrist 8.4%, hand 6.5%, hip 1.9%, knee 21.3%, ankle 4.5%, great toe 1.9%, cervical spine 11.6%, dorsal and lumbar spine 18.1%, and other 9.7%. The incidence of past and present musculoskeletal complaint was 57.4% (95% CI 5.8). The present disability in activities of daily living (mild to severe) was 23.9% (95% CI 5). Rheumatologic diagnoses were degenerative joint disease (neck 0.7%, lumbar spine 0.7%, knee 9.8%, multiple joints 2.1%, other 2.4%), low back pain 2.8%, sciatica 0.35%, 'tennis elbow' 0.7%, shoulder tenosynovitis 0.7%, and other tendonitis/tenosynovitis 1.1%. No inflammatory disorder was detected. The pilot study helped to finalize the plans for the larger COPCORD study itself, designed to evaluate 10,000 persons. The ethnic distribution in the evaluated population closely resembles the estimated figure for Iran2. The number of interviewed persons was too low to estimate rheumatologic disorders correctly, and thus our results must be interpreted with caution. FEREYDOUN DAVATCHI, MD, Professor and Head; AHMAD-REZA JAMSHIDI, MD, Associate Professor; ARASH TEHRANI BANI-HASHEMI, MD, Rheumatology Research Center, Shariati Hospital, Tehran University for Medical Sciences, Tehran 14114, Iran; JOHN DARMAWAN, MD, PhD, WHO-ILAR COPCORD Coordinator.
Supported by a grant from Tehran University for Medical Sciences. REFERENCES
1. Forghanizadeh J, Abhari R, Piroozian M, et al. Prevalence of 2. Davatchi F, Shahram F. Epidemiology of Behcet's disease in Iran. In: Bang D, Lee ES, Lee S, editors. Behcet's disease. Seoul, Korea: Design Mecca Publishing Co.; 2000:589-91. |