ArticlesChronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study
Introduction
Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. However, it is often underdiagnosed and undertreated, resulting in underestimation of the burden of this disease.1 The prevalence of COPD in many developed countries seems to be increasing.2, 3, 4 There is also some evidence from Latin American countries that COPD is a growing cause of death,5 but population-based prevalence data are virtually non-existent.6 To obtain a detailed picture of the global distribution of this severe condition, it is necessary to estimate its prevalence in less developed countries. Prevalence surveys could also help to identify new risk factors and measure the prevalence of known determinants.
The prevalence of the main risk factor for COPD—smoking—is high in Latin America. Mean annual cigarette consumption per person in most countries of Latin America ranges from 500 to 1499.7 As in most high-income countries, there is some evidence that smoking prevalence in men is slightly declining, whereas for women it is rising.7 Even if smoking prevalence rates fall slightly, the absolute number of smokers could increase because of population growth. The relative importance of other known risk factors for COPD has not been adequately assessed in Latin America.
The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was launched in 2002 with the objective of measuring COPD prevalence and associated risk factors in five major cities in Latin America: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay), and Caracas (Venezuela). These sites were chosen because of their geographical position, population size, and the availability of local collaborating research centres. They represent the different geographical areas of Latin America and the largest metropolitan area in each participating country. Their combined population is about 50 million, of whom around a third are 40 years or older. We report COPD prevalence in these five areas.
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Study design
A similar multistage sampling strategy was used in all five areas. Metropolitan areas were first stratified into the main city and surrounding municipalities. These two subsets were further stratified by socioeconomic status. We selected 68 census tracts at each site, taking stratification into account and using a probability of selection proportionate to the number of households in each tract. Within each tract, we counted the number of people in each household and every count was updated from
Results
The contact failure rate at the household level was highest in Caracas, and questionnaire completion was lowest in Mexico City (table 1). Completion of spirometry was uniformly high. Information about age, sex, and smoking were obtained from approximately 50% of individuals who were identified but refused to respond to the questionnaire. On the basis of this information, we estimate that non-response was consistently higher for men, but only slightly higher among older people and current
Discussion
In people aged 40 years and older, we measured a crude prevalence of COPD ranging from 7·8% in Mexico City to almost 20% in Montevideo. The public health effect of this disease has yet to be fully explored in the region, but the PLATINO study is an important first step.
These results are higher than the expected range of 4–10% from an international review of COPD prevalence.18 Nevertheless, they are consistent with the only published population-based study of COPD in Latin America in which,
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