TY - JOUR
T1 - Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019
T2 - a systematic review and modelling analysis
AU - NIHR RESPIRE Global Respiratory Health Unit
AU - Adeloye, Davies
AU - Song, Peige
AU - Zhu, Yajie
AU - Campbell, Harry
AU - Sheikh, Aziz
AU - Rudan, Igor
N1 - Funding Information:
This research was commissioned by the NIHR Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government. The views expressed in this Article are those of the author(s) and do not necessarily represent those of the NIHR or the UK Department of Health and Social Care. We also acknowledge the support of BREATHE-The Health Data Research Hub for Respiratory Health (grant number MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. The RESPIRE collaboration comprises the UK grant holders, partners, and research teams as listed on the RESPIRE website (www.ed.ac.uk/usher/respire), including Aziz Sheikh (author), Harry Campbell (author), Igor Rudan (author), Davies Adeloye (author), Biswajit Paul, Anand Kawade, Osman Yusuf, Harish Nair, David Rockwell, Siân Williams, and Sundeep Salvi.
Funding Information:
This research was commissioned by the NIHR Global Health Research Unit on Respiratory Health (RESPIRE), using UK Aid from the UK Government. The views expressed in this Article are those of the author(s) and do not necessarily represent those of the NIHR or the UK Department of Health and Social Care. We also acknowledge the support of BREATHE-The Health Data Research Hub for Respiratory Health (grant number MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. The RESPIRE collaboration comprises the UK grant holders, partners, and research teams as listed on the RESPIRE website ( www.ed.ac.uk/usher/respire ), including Aziz Sheikh (author), Harry Campbell (author), Igor Rudan (author), Davies Adeloye (author), Biswajit Paul, Anand Kawade, Osman Yusuf, Harish Nair, David Rockwell, Siân Williams, and Sundeep Salvi.
Funding Information:
AS reports grants from health data research (HDR) UK BREATHE Hub, UK Medical Research Council, and UK National Institute for Health Research (NIHR), during the conduct of the study. All other authors declare no competing interests.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
PY - 2022/3/10
Y1 - 2022/3/10
N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an increasingly important cause of morbidity, disability, and mortality worldwide. We aimed to estimate global, regional, and national COPD prevalence and risk factors to guide policy and population interventions.METHODS: For this systematic review and modelling study, we searched MEDLINE, Embase, Global Health, and CINAHL, for population-based studies on COPD prevalence published between Jan 1, 1990, and Dec 31, 2019. We included data reported using the two main case definitions: the Global Initiative for Chronic Obstructive Lung Disease fixed ratio (GOLD; FEV1/FVC<0·7) and the lower limit of normal (LLN; FEV1/FVC<LLN). We employed a multilevel multivariable mixed-effects meta-regression approach to generate the age-specific and sex-specific prevalence of COPD in 2019 for high-income countries (HICs) and low-income and middle-income countries (LMICs) according to the World Bank definition. Common risk factors for GOLD-COPD were evaluated using a random-effects meta-analysis.FINDINGS: We identified 162 articles reporting population-based studies conducted across 260 sites in 65 countries. In 2019, the global prevalence of COPD among people aged 30-79 years was 10·3% (95% CI 8·2-12·8) using the GOLD case definition, which translates to 391·9 million people (95% CI 312·6-487·9), and 7·6% (5·8-10·1) using the LLN definition, which translates to 292·0 million people (219·8-385·6). Using the GOLD definition, we estimated that 391·9 million (95% CI 312·6-487·9) people aged 30-79 years had COPD worldwide in 2019, with most (315·5 million [246·7-399·6]; 80·5%) living in LMICs. The overall prevalence of GOLD-COPD among people aged 30-79 years was the highest in the Western Pacific region (11·7% [95% CI 9·3-14·6]) and lowest in the region of the Americas (6·8% [95% CI 5·6-8·2]). Globally, male sex (OR 2·1 [95% CI 1·8-2·3]), smoking (current smoker 3·2 [2·5-4·0]; ever smoker 2·3 [2·0-2·5]), body-mass index of less than 18·5 kg/m2 (2·2 [1·7-2·7]), biomass exposure (1·4 [1·2-1·7]), and occupational exposure to dust or smoke (1·4 [1·3-1·6]) were all substantial risk factors for COPD.INTERPRETATION: With more than three-quarters of global COPD cases in LMICs, tackling this chronic condition is a major and increasing challenge for health systems in these settings. In the absence of targeted population-wide efforts and health system reforms in these settings, many of which are under-resourced, achieving a substantial reduction in the burden of COPD globally might remain a difficult task.FUNDING: National Institute for Health Research and Health Data Research UK.
AB - BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an increasingly important cause of morbidity, disability, and mortality worldwide. We aimed to estimate global, regional, and national COPD prevalence and risk factors to guide policy and population interventions.METHODS: For this systematic review and modelling study, we searched MEDLINE, Embase, Global Health, and CINAHL, for population-based studies on COPD prevalence published between Jan 1, 1990, and Dec 31, 2019. We included data reported using the two main case definitions: the Global Initiative for Chronic Obstructive Lung Disease fixed ratio (GOLD; FEV1/FVC<0·7) and the lower limit of normal (LLN; FEV1/FVC<LLN). We employed a multilevel multivariable mixed-effects meta-regression approach to generate the age-specific and sex-specific prevalence of COPD in 2019 for high-income countries (HICs) and low-income and middle-income countries (LMICs) according to the World Bank definition. Common risk factors for GOLD-COPD were evaluated using a random-effects meta-analysis.FINDINGS: We identified 162 articles reporting population-based studies conducted across 260 sites in 65 countries. In 2019, the global prevalence of COPD among people aged 30-79 years was 10·3% (95% CI 8·2-12·8) using the GOLD case definition, which translates to 391·9 million people (95% CI 312·6-487·9), and 7·6% (5·8-10·1) using the LLN definition, which translates to 292·0 million people (219·8-385·6). Using the GOLD definition, we estimated that 391·9 million (95% CI 312·6-487·9) people aged 30-79 years had COPD worldwide in 2019, with most (315·5 million [246·7-399·6]; 80·5%) living in LMICs. The overall prevalence of GOLD-COPD among people aged 30-79 years was the highest in the Western Pacific region (11·7% [95% CI 9·3-14·6]) and lowest in the region of the Americas (6·8% [95% CI 5·6-8·2]). Globally, male sex (OR 2·1 [95% CI 1·8-2·3]), smoking (current smoker 3·2 [2·5-4·0]; ever smoker 2·3 [2·0-2·5]), body-mass index of less than 18·5 kg/m2 (2·2 [1·7-2·7]), biomass exposure (1·4 [1·2-1·7]), and occupational exposure to dust or smoke (1·4 [1·3-1·6]) were all substantial risk factors for COPD.INTERPRETATION: With more than three-quarters of global COPD cases in LMICs, tackling this chronic condition is a major and increasing challenge for health systems in these settings. In the absence of targeted population-wide efforts and health system reforms in these settings, many of which are under-resourced, achieving a substantial reduction in the burden of COPD globally might remain a difficult task.FUNDING: National Institute for Health Research and Health Data Research UK.
KW - Chronic Disease
KW - Female
KW - Global Health
KW - Humans
KW - Male
KW - Prevalence
KW - Pulmonary Disease, Chronic Obstructive/epidemiology
KW - Risk Factors
U2 - 10.1016/S2213-2600(21)00511-7
DO - 10.1016/S2213-2600(21)00511-7
M3 - Article
C2 - 35279265
SN - 2213-2600
VL - 10
SP - 447
EP - 458
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 5
ER -