Chest
Volume 123, Issue 5, May 2003, Pages 1684-1692
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Special Reports
Interpreting COPD Prevalence Estimates: What Is the True Burden of Disease?

https://doi.org/10.1378/chest.123.5.1684Get rights and content

Study objectives:

To summarize the available data on COPD prevalence and assess reasons for conflicting prevalence estimates in the published literature.

Design:

We reviewed published studies that (1) estimated COPD prevalence for a population, and (2) clearly described the methods used to obtain the estimates.

Results:

Thirty-two sources of COPD prevalence rates, representing 17 countries and eight World Health Organization-classified regions, were identified and reviewed. Prevalence estimates were based on spirometry (11 studies), respiratory symptoms (14 studies), patient-reported disease (10 studies), or expert opinion. Reported prevalence ranged from 0.23 to 18.3%. The lowest prevalence rates (0.2 to 2.5%) were based on expert opinion. Sixteen studies had measured rates that could reasonably be extrapolated to an entire region or country. All were for Europe or North America, and most fell between 4% and 10%.

Conclusions:

There is considerable variation in the reported prevalence of COPD. The overall prevalence in adults appears to lie between 4% and 10% in countries where it has been rigorously measured. Some of the variation attributed to differences in risk exposure or population characteristics may be influenced by the methods and definitions used to measure disease. Spirometry is least influenced by local diagnostic practice, but it is subject to variation based on the lung function parameters selected to define COPD.

Section snippets

Materials and Methods

A MEDLINE literature search was performed using a strategy that included the medical subject heading term lung diseases, obstructive and key words COPD, chronic bronchitis, emphysema, prevalence, epidemiology, age, smoking, and risk factors, in various combinations. The search period included the entire MEDLINE database, extending back to the mid-1960s. The abstracts for articles identified were reviewed, and relevant articles were selected for retrieval and analysis. The focus of the review

Results

We found 32 sources of COPD prevalence that described the methodology used to calculate prevalence (Table 1).9121314151617181920212223242526272829303132333435363738394041424344 These reports were published between 1962 and 2001. All but three of these sources were single-country studies, representing 17 countries, mostly in the developed world. Several developed countries had more than one published prevalence study: these included Canada, England, Norway and Spain (two studies each), Finland

Discussion

The COPD prevalence data presented here demonstrate the paucity of well-designed epidemiologic studies from most regions in the world. In many areas, available information gives an impression of very low prevalence rates. Consequently, policymakers in these areas—thinking that COPD is relatively uncommon—often assign a low priority to COPD when allocating health expenditures. Physicians in these areas may be less likely to suspect COPD, and less likely to correctly diagnose it, reinforcing the

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    At the time of initial manuscript preparation, all authors were employees of Protocare Sciences, a firm offering consulting services to the health-care industry, including pharmaceutical manufacturers.

    This work was supported by a grant from Boehringer Ingelheim GmbH.

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