Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis

Davies Adeloye, Peige Song, Yajie Zhu, Harry Campbell, Aziz Sheikh, Igor Rudan, NIHR RESPIRE Global Respiratory Health Unit, Davies Adeloye, Peige Song, Yajie Zhu, Harry Campbell, Aziz Sheikh, Igor Rudan, NIHR RESPIRE Global Respiratory Health Unit

Abstract

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.

Conflict of interest statement

Declaration of interests 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.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2
Contributing data sources across world regions COPD=chronic obstructive pulmonary disease. GOLD=Global Initiative on Obstructive Lung Disease. HICs=high-income countries. LLN=lower limit of normal. LMICs=low-income and middle-income countries. *Seychelles is a high-income country according to the latest World Bank income classification, but classified into the low-income and middle-income African region because of its relatively small population size. GOLD-COPD is defined as FEV1/FVC<0·7, whereas LLN-COPD is defined as FEV1/FVC<LLN.
Figure 3
Figure 3
Number of people with GOLD-COPD by region and age groups in 2019 COPD=chronic obstructive pulmonary disease. GOLD=Global Initiative on Obstructive Lung Disease. HICs=high-income countries. LMICs=low-income and middle-income countries. GOLD-COPD is defined as FEV1/FVC<0·7.

References

    1. Soriano JB, Kendrick PJ, Paulson KR, et al. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Respir Med. 2020;8:585–596.
    1. Lange P, Celli B, Agustí A, et al. Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med. 2015;373:111–122.
    1. Burney P, Jarvis D, Perez-Padilla R. The global burden of chronic respiratory disease in adults. Int J Tuberc Lung Dis. 2015;19:10–20.
    1. Soriano JB, Abajobir AA, Abate KH, et al. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5:691–706.
    1. Baarnes CB, Kjeldgaard P, Nielsen M, Miravitlles M, Ulrik CS. Identifying possible asthma-COPD overlap syndrome in patients with a new diagnosis of COPD in primary care. NPJ Prim Care Respir Med. 2017;27
    1. Lopez-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology. 2016;21:14–23.
    1. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370:741–750.
    1. Roth GA, Abate D, Abate KH, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788.
    1. Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;49
    1. Global Initiative for Chronic Obstructive Lung Disease Global strategy for diagnosis, management and prevention of chronic obstructive pulmonary disease: 2021 report.
    1. Lamprecht B, Soriano JB, Studnicka M, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest. 2015;148:971–985.
    1. Diab N, Gershon AS, Sin DD, et al. Underdiagnosis and overdiagnosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2018;198:1130–1139.
    1. Gershon AS, Thiruchelvam D, Chapman KR, et al. Health services burden of undiagnosed and overdiagnosed COPD. Chest. 2018;153:1336–1346.
    1. Adeloye D, Chua S, Lee C, et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Glob Health. 2015;5
    1. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
    1. Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet. 2016;388:e19–e23.
    1. Baranyi G, Scholl C, Fazel S, Patel V, Priebe S, Mundt AP. Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: a systematic review and meta-analysis of prevalence studies. Lancet Glob Health. 2019;7:e461–e471.
    1. UN. Department of Economic and Social Affairs. Population Division . United Nations; New York, NY: 2019. World population prospects 2019.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188.
    1. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28:523–532.
    1. Varmaghani M, Dehghani M, Heidari E, Sharifi F, Moghaddam SS, Farzadfar F. Global prevalence of chronic obstructive pulmonary disease: systematic review and meta-analysis. East Mediterr Health J. 2019;25:47–57.
    1. Blanco I, Diego I, Bueno P, Casas-Maldonado F, Miravitlles M. Geographic distribution of COPD prevalence in the world displayed by Geographic Information System maps. Eur Respir J. 2019;54
    1. Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–1259.
    1. WHO Chronic obstructive pulmonary disease (COPD) 2017.
    1. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858.
    1. Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222.
    1. Tan WC. Trends in chronic obstructive pulmonary disease in the Asia-Pacific regions. Curr Opin Pulm Med. 2011;17:56–61.
    1. Chan KY, Li X, Chen W, et al. Prevalence of chronic obstructive pulmonary disease (COPD) in China in 1990 and 2010. J Glob Health. 2017;7
    1. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet. 2018;391:1706–1717.
    1. India State-Level Disease Burden Initiative CRDC The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990–2016. Lancet Glob Health. 2018;6:e1363–e1374.
    1. Burney P, Patel J, Minelli C, et al. Prevalence and population attributable risk for chronic airflow obstruction in a large multinational study. Am J Respir Crit Care Med. 2020;203:1353–1365.
    1. van Gemert FA, Kirenga BJ, Gebremariam TH, Nyale G, de Jong C, van der Molen T. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa. Expert Rev Respir Med. 2018;12:227–237.
    1. Salvi S. The silent epidemic of COPD in Africa. Lancet Glob Health. 2015;3:e6–e7.
    1. Hooper R, Burney P, Vollmer WM, et al. Risk factors for COPD spirometrically defined from the lower limit of normal in the BOLD project. Eur Respir J. 2012;39:1343–1353.
    1. Hanafi NS, Agarwal D, Chippagiri S, et al. Chronic respiratory disease surveys in low- and middle-income countries (LMICs): a systematic scoping review of methodologies and outcomes. J Glob Health. 2021;11
    1. Cerveri I, De Marco R. What makes large epidemiological studies comparable? Eur Respir J. 2010;36:720–721.
    1. Perez-Padilla R, Wehrmeister FC, Celli BR, et al. Reliability of FEV1/FEV6 to diagnose airflow obstruction compared with FEV1/FVC: the PLATINO longitudinal study. PLoS One. 2013;8
    1. Qiu H, Tan K, Long F, et al. The burden of COPD morbidity attributable to the interaction between ambient air pollution and temperature in Chengdu, China. Int J Environ Res Public Health. 2018;15:492.
    1. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370:765–773.
    1. Martin A, Badrick E, Mathur R, Hull S. Effect of ethnicity on the prevalence, severity, and management of COPD in general practice. Br J Gen Pract. 2012;62:e76–e81.
    1. Marks GB. Guiding policy to reduce the burden of COPD: the role of epidemiological research. Thorax. 2018;73:405–406.
    1. Van Schayck OCP, Williams S, Barchilon V, et al. Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG. NPJ Prim Care Respir Med. 2017;27:38.
    1. Troosters T, Blondeel A, Janssens W, Demeyer H. The past, present and future of pulmonary rehabilitation. Respirol. 2019;24:830–837.
    1. Williams S, Sheikh A, Campbell H, et al. Respiratory research funding is inadequate, inequitable, and a missed opportunity. Lancet Respir Med. 2020;8:e67–e68.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi