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Prevalence and Population Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study

Burney P 1 , Patel J 2 , Minelli C 3 , Gnatiuc L 4 , Amaral AFS 5 , Kocabaş A 6 Show all authors , Cherkaski HH 7 , Gulsvik A 8 , Nielsen R 9 , Bateman E 10 , Jithoo A 11 , Mortimer K 12 , Sooronbaev TM 13 , Lawin H 14 , Nejjari C 15 , Elbiaze M 16 , El Rhazi K 16 , Zheng JP 17 , Ran P 18 , Welte T 19 , Obaseki D 20 , Erhabor G 20 , Elsony A 21 , Osman NB 21 , Ahmed R 21 , Nizankowska-Mogilnicka E 22 , Mejza F 22 , Mannino DM 23 , Bárbara C 24 , Wouters EFM 25 , Idolor LF 26 , Loh LC 27 , Rashid A 28 , Juvekar S 29 , Gislason T 30 , Al Ghobain M 31 , Studnicka M 32 , Harrabi I 33 , Denguezli M 34 , Koul PA 35 , Jenkins C 36 , Marks G 37 , Jõgi R 38 , Hafizi H 39 , Janson C 40 , Tan WC 41 , Aquart-Stewart A 42 , Mbatchou B 43 , Nafees A 44 , Gunasekera K 45 , Seemungal T 46 , Padukudru Anand M 47 , Enright P 48 , Vollmer WM 49 , Blangiardo M 50 , Elfadaly FG 51 , Buist AS 52

Affiliations 

  • 1 Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland
  • 2 Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland
  • 3 Imperial College, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
  • 4 University of Oxford, 6396, Oxford, United Kingdom of Great Britain and Northern Ireland
  • 5 Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland; a.amaral@imperial.ac.uk
  • 6 Cukurova Universitesi Tip Fakultesi, 63988, Pulmonary Disease, Adana, Turkey
  • 7 Faculty of Medecine and CHU Annaba, Annaba, Algeria
  • 8 University of Bergen, 1658, Department of Thoracic Medicine, Institute of Medicine, Bergen, Norway
  • 9 University of Bergen, 1658, Bergen, Norway
  • 10 UCT Lung Institute, Cape Town, South Africa
  • 11 University of Cape Town Lung Institute, 108145, Cape Town, South Africa
  • 12 Liverpool School of Tropical Medicine and Aintree University Hospital NHS Foundation Trust, Respiratory Medicine, Liverpool, United Kingdom of Great Britain and Northern Ireland
  • 13 National Center of Internal Medicine and Cardiology, Bishkek, Kyrgyzstan
  • 14 University of Abomey-Calavi, 107790, Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, Cotonou, Benin
  • 15 Laboratoire d'épidémiologie, Recherche Clinique et Santé Communautaire, Fes, Morocco
  • 16 Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
  • 17 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
  • 18 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China, Guangzhou, China
  • 19 Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
  • 20 Obafemi Awolowo University, Medicine, Ile-Ife, Nigeria
  • 21 Epi-Lab, 539991, Khartoum, Sudan
  • 22 Jagiellonian University Medical College, 49573, Krakow, Poland
  • 23 Medical Expert at GlaxoSmithKline, Lexington, Kentucky, United States
  • 24 Hospital Pulido Valente, 70896, Unidade de Técnicas Invasivas Pneumológicas, Pneumologia II, Lisboa, Portugal
  • 25 Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
  • 26 Philippine College of Chest Physicians, Manila, Philippines
  • 27 Penang Medical College, 26696, Georgetown, Malaysia
  • 28 Royal College of Surgeons of Ireland and University College Dublin, Malaysia Campus, Penang, Malaysia
  • 29 KEM Hospital Pune, 72911, Pune, India
  • 30 Landspitali University Hospital, Reykjavik, Iceland
  • 31 Saudi Thoracic Society, 540697, Riyadh, Saudi Arabia
  • 32 Paracelsus Medical University, Pneumology, Salzburg, Austria
  • 33 Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia
  • 34 Universite de Sousse Faculte de Medecine de Sousse, 280226, Sousse, Tunisia
  • 35 Sher-i-Kashmir Institute of Medical Sciences, 29078, Internal Medicine, Srinagar, India
  • 36 Woolcock Institute of Medical Research, Mosman, Australia
  • 37 Institute of Respiratory Medicine, Campertown, New South Wales, Australia
  • 38 Foundation Tartu University Clinics, Lung Clinic, Tartu, Estonia
  • 39 Tirana University Hospital, Tirana, Albania
  • 40 Uppsala Uiversity, Dep of Respiratory Medicine, Uppsala, Sweden
  • 41 Univ British Columbia, icapture center, vancouver, British Columbia, Canada
  • 42 University of the West Indies, 62707, Kingston, Jamaica
  • 43 Douala General Hospital, Douala, Cameroon
  • 44 Aga Khan University, 9615, Karachi, Pakistan
  • 45 Medical Research Institute Sri Lanka, 295494, Colombo, Sri Lanka
  • 46 University of the West Indies, Clinical Medical Sciences, Champs Fleurs, Trinidad and Tobago
  • 47 JSS Academy of Higher Education and Research, Department of Pulmonary Medicine, JSS Medical College, , Mysore, India
  • 48 University of Arizona, Medicine, Tucson, Arizona, United States
  • 49 Center for Health Research, Portland, Oregon, United States
  • 50 Imperial College London School of Public Health, 156430, Department of Epidemiology and Biostatistics, London, United Kingdom of Great Britain and Northern Ireland
  • 51 The Open University, 5488, Milton Keynes, United Kingdom of Great Britain and Northern Ireland
  • 52 Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States
Am J Respir Crit Care Med, 2020 Nov 10.
PMID: 33171069 DOI: 10.1164/rccm.202005-1990OC

Abstract

Rationale: The Global Burden of Disease programme identified smoking, and ambient and household air pollution as the main drivers of death and disability from Chronic Obstructive Pulmonary Disease (COPD). Objective: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a post-bronchodilator one-second forced expiratory volume to forced vital capacity ratio < lower limit of normal, and the relative risks associated with different risk factors. Local RR were estimated using a Bayesian hierarchical model borrowing information from across sites. From these RR and the prevalence of risk factors, we estimated local Population Attributable Risks (PAR). Measurements and Main Results: Mean prevalence of CAO was 11.2% in men and 8.6% in women. Mean PAR for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index (BMI), and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: While smoking remains the most important risk factor for CAO, in some areas poor education, low BMI and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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