RT Journal Article
SR Electronic
T1 Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty—a BOLD analysis
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 465
OP 473
DO 10.1136/thoraxjnl-2013-204460
VO 69
IS 5
A1 Peter Burney
A1 Anamika Jithoo
A1 Bernet Kato
A1 Christer Janson
A1 David Mannino
A1 Ewa Niżankowska-Mogilnicka
A1 Michael Studnicka
A1 Wan Tan
A1 Eric Bateman
A1 Ali Koçabas
A1 William M Vollmer
A1 Thorarrin Gislason
A1 Guy Marks
A1 Parvaiz A Koul
A1 Imed Harrabi
A1 Louisa Gnatiuc
A1 Sonia Buist
A1 for the Burden of Obstructive Lung Disease (BOLD) Study
YR 2014
UL http://thorax.bmj.com/content/69/5/465.abstract
AB 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 ‘COPD’ mortality in poor countries.