@article {Burney465, author = {Peter Burney and Anamika Jithoo and Bernet Kato and Christer Janson and David Mannino and Ewa Ni{\.z}ankowska-Mogilnicka and Michael Studnicka and Wan Tan and Eric Bateman and Ali Ko{\c c}abas and William M Vollmer and Thorarrin Gislason and Guy Marks and Parvaiz A Koul and Imed Harrabi and Louisa Gnatiuc and Sonia Buist and for the Burden of Obstructive Lung Disease (BOLD) Study}, editor = {Zhong, NanShan and Liu, Shengming and Lu, Jiachun and Ran, Pixin and Wang, Dali and Zheng, Jingping and Zhou, Yumin and Kocaba{\c s}, Ali and Hancioglu, Attila and Hanta, Ismail and Kuleci, Sedat and Turkyilmaz, Ahmet Sinan and Umut, Sema and Unalan, Turgay and Studnicka, Michael and Dawes, Torkil and Lamprecht, Bernd and Schirhofer, Lea and Bateman, Eric and Jithoo, Anamika and Adams, Desiree and Barnes, Edward and Freeman, Jasper and Hayes, Anton and Hlengwa, Sipho and Johannisen, Christine and Koopman, Mariana and Louw, Innocentia and Ludick, Ina and Olckers, Alta and Ryck, Johanna and Storbeck, Janita and Gislason, Thorarinn and Benedikdtsdottir, Bryndis and J{\"o}rundsdottir, Kristin and Gudmundsdottir, Lovisa and Gudmundsdottir, Sigrun and Gundmundsson, Gunnar and Nizankowska-Mogilnicka, Ewa and Frey, Jakub and Harat, Rafal and Mejza, Filip and Nastalek, Pawel and Pajak, Andrzej and Skucha, Wojciech and Szczeklik, Andrzej and Twardowska, Magda and Welte, Tobias and Bodemann, Isabelle and Geldmacher, Henning and Schweda-Linow, Alexandra and Gulsvik, Amund and Endresen, Tina and Svendsen, Lene and Tan, Wan C and Wang, Wen and Mannino, David M and Cain, John and Copeland, Rebecca and Hazen, Dana and Methvin, Jennifer and Dantes, Renato B and Amarillo, Lourdes and Berratio, Lakan U and Fernandez, Lenora C and Francisco, Norberto A and Garcia, Gerard S and de Guia, Teresita S and Idolor, Luisito F and Naval, Sullian S and Reyes, Thessa and Roa, Camilo C and Sanchez, Ma Flordeliza and Simpao, Leander P and Jenkins, Christine and Marks, Guy and Bird, Tessa and Espinel, Paola and Hardaker, Kate and Toelle, Brett and Burney, Peter G J and Amor, Caron and Potts, James and Tumilty, Michael and McLean, Fiona and Wouters, E F M and Wesseling, G J and B{\'a}rbara, Cristina and Rodrigues, F{\'a}tima and Dias, Herm{\'\i}nia and Cardoso, Jo{\~a}o and Almeida, Jo{\~a}o and Matos, Maria Jo{\~a}o and Sim{\~a}o, Paula and Santos, Moutinho and Ferreira, Reis and Janson, Christer and Olafsdottir, Inga Sif and Nisser, Katarina and Spetz-Nystr{\"o}m, Ulrike and H{\"a}gg, Gunilla and Lund, Gun-Marie and J{\~o}gi, Rain and Laja, Hendrik and Ulst, Katrin and Zobel, Vappu and Lill, Toomas-Julius and Koul, Parvaiz A and Malik, Sajjad and Hakim, Nissar A and Khan, Umar Hafiz and Chowgule, Rohini and Shetye, Vasant and Raphael, Jonelle and Almeda, Rosel and Tawde, Mahesh and Tadvi, Rafiq and Katkar, Sunil and Kadam, Milind and Dhanawade, Rupesh and Ghurup, Umesh and Harrabi, Imed and Denguezli, Myriam and Tabka, Zouhair and Daldoul, Hager and Boukheroufa, Zaki and Chouikha, Firas and Khalifa, Wahbi Belhaj and Idolor, Luisito F and de Guia, Teresita S and Francisco, Norberto A and Roa, Camilo C and Ayuyao, Fernando G and Tady, Cecil Z and Tan, Daniel T and Banal-Yang, Sylvia and Balanag, Vincent M and Reyes, Maria Teresita N and Dantes, Renato B and Salvi, Sundeep and Hirve, Siddhi and Brashier, Bill and Londhe, Jyoti and Madas, Sapna and Sambhudas, Somnath and Chaidhary, Bharat and Tambe, Meera and Pingale, Savita and Umap, Arati and Umap, Archana and Shelar, Nitin and Devchakke, Sampada and Chaudhary, Sharda and Bondre, Suvarna and Walke, Savita and Gawhane, Ashleshsa and Sapkal, Anil and Argade, Rupali and Gaikwad, Vijay and Crapo, R O and Jensen, R L and Enright, Paul and Harnoncourt, Georg}, title = {Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty{\textemdash}a BOLD analysis}, volume = {69}, number = {5}, pages = {465--473}, year = {2014}, doi = {10.1136/thoraxjnl-2013-204460}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Chronic obstructive pulmonary disease (COPD) is a commonly reported cause of death and associated with smoking. However, COPD mortality is high in poor countries with low smoking rates. Spirometric restriction predicts mortality better than airflow obstruction, suggesting that the prevalence of restriction could explain mortality rates attributed to COPD. We have studied associations between mortality from COPD and low lung function, and between both lung function and death rates and cigarette consumption and gross national income per capita (GNI). Methods National COPD mortality rates were regressed against the prevalence of airflow obstruction and spirometric restriction in 22 Burden of Obstructive Lung Disease (BOLD) study sites and against GNI, and national smoking prevalence. The prevalence of airflow obstruction and spirometric restriction in the BOLD sites were regressed against GNI and mean pack years smoked. Results National COPD mortality rates were more strongly associated with spirometric restriction in the BOLD sites (\<60 years: men rs=0.73, p=0.0001; women rs=0.90, p\<0.0001; 60+ years: men rs=0.63, p=0.0022; women rs=0.37, p=0.1) than obstruction (\<60 years: men rs=0.28, p=0.20; women rs=0.17, p\<0.46; 60+ years: men rs=0.28, p=0.23; women rs=0.22, p=0.33). Obstruction increased with mean pack years smoked, but COPD mortality fell with increased cigarette consumption and rose rapidly as GNI fell below US$15 000. Prevalence of restriction was not associated with smoking but also increased rapidly as GNI fell below US$15 000. Conclusions Smoking remains the single most important cause of obstruction but a high prevalence of restriction associated with poverty could explain the high {\textquoteleft}COPD{\textquoteright} mortality in poor countries.}, issn = {0040-6376}, URL = {https://thorax.bmj.com/content/69/5/465}, eprint = {https://thorax.bmj.com/content/69/5/465.full.pdf}, journal = {Thorax} }