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We are grateful to Dr Stanojevic and her colleagues1 for their interest in our paper.2
On their first point we assume that they mean mortality rates not national prevalence rates. In either case the weak association between diagnosis and spirometric findings is already well known and unsurprising given that very few people have spirometric testing. In the case of death certificates the situation is further confounded by the limited choice of International Classification of Disease codes for people dying with chronic lung disease.
Their second paragraph deals with two separate issues, the potential divergence between national and local statistics and the interpretation of ecological analyses. They are right to repeat our caveat that national data do not necessarily reflect local conditions. For gross …
Footnotes
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Contributors PB drafted the response and finalised it. The other authors commented on the first draft and agreed the final document.
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Competing interests PB reports grants from Wellcome Trust and the UK Department of Health, during the conduct of the study; other from Glaxo Smith Kline, outside the submitted work; WMV reports grants from Merck, grants from Boehringer Ingelheim, Pfizer, Altana GlaxoSmithKline, AstraZeneca, Novartis, and Chiesi, during the conduct of the study; DM has received honoraria/consulting fees and research funding from GlaxoSmithKline plc, Novartis Pharmaceuticals, Pfizer Inc., Boehringer-Ingelheim, AstraZeneca PLC, Forest Laboratories Inc., Merck, and Creative Educational Concepts. Furthermore, he has received royalties from Up-to-Date. WT reports grants from Joint sponsorship by GSK, AZ, BI, Altana, Norvatis, Pfizer, outside the submitted work; MS reports grants from Altana, Astra-Zeneca, Boehringer-Ingelheim, Glaxo-Smith-Kline, Merck Sharpe & Dome, Novartis, Salzburger Gebietskrankenkasse, and Salzburg Local Government during the conduct of the study; grants and personal fees from Boehringer-Ingelheim, Altana-Nycomed, Chiesi and Astra-Zeneca, grants and non-financial support from Air-Liquide, and personal fees from Menarini, and Glaxo-Smith-Kline outside the submitted work; GM reports grants from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Air Liquide, Australian Lung Foundation, National Health and Medical Research Council during the conduct of the study; other from Novartis, outside the submitted work.
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Provenance and peer review Not commissioned; internally peer reviewed.