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Correspondence
Disentangling the discordance between epidemiological associations and physiological mechanisms
  1. Sanja Stanojevic1,
  2. Tim J Cole2,
  3. Janet Stocks3,
  4. Philip H Quanjer4
  1. 1Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
  3. 3Portex Respiratory Unit, UCL Institute of Child Health, London, UK
  4. 4Department of Pulmonary Diseases and Department of Paediatrics-Pulmonary Diseases, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
  1. Correspondence to Dr Sanja Stanojevic, Department of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; Sanja.Stanojevic{at}sickkids.ca

https://doi.org/10.1136/thoraxjnl-2014-205396

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    Burney et al1 recently presented an ecological analysis of Burden of Obstructive Lung Disease (BOLD) study data to investigate the association between chronic obstructive pulmonary disease (COPD) prevalence and mortality with smoking and poverty. It is striking that no association was observed between the national prevalence rates of COPD and airflow limitation. This raises serious questions about the accuracy of COPD diagnosis, and suggests that COPD was considerably overdiagnosed. Despite this, the authors’ main conclusion is that the high COPD mortality in low-income countries is associated with spirometric restriction, but the case for this is unconvincing.

    There are several methodological reasons why the findings need …

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    Footnotes

    • Contributors SS conceived the idea and wrote the draft letter. TJC revised and edited the letter. JS revised and edited the letter. PHQ conceived the idea and revised and edited the letter. All authors have given permission to submit this work. SS will act as the guarantor.

    • Competing interests The authors declare that as members of the Global Lung Function Initiative they have a competing interest.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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      Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty: a BOLD analysis—authors’ reply
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      Thorax 2014; 69 869-870 Published Online First: 01 May 2014. doi: 10.1136/thoraxjnl-2014-205474