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Geographic Variations in Prevalence and Underdiagnosis of COPD

2000; Elsevier BV; Volume: 118; Issue: 4 Linguagem: Inglês

10.1378/chest.118.4.981

1931-3543

Victor Sobradillo Penña, Marc Miravitlles, Rafael Gabriel, Carlos A. Jiménez-Ruiz, Carlos Villasante, Juan F. Masa, José Luís Viejo, L. Fernández-Fau,

Respiratory Support and Mechanisms

Objectives: To ascertain the prevalence, diagnostic level, and treatment of COPD in Spain through a multicenterstudy comprising seven different geographic are as. Designand participants: This is an epidemiologic, multicenter, population-based study conducted in seven are as of Spain. A total of4,035 men and women (age range, 40 to 69 years) who were randomlyselected from a target population of 236,412 subjects participated inthe study. Interventions: Eligible subjects answeredthe European Commission for Steel and Coal questionnaire. Spirometrywas performed, followed by a bronchodilator test when bronchialobstruction was present. Results: The prevalence of COPD was 9.1% (95% confidence interval [CI], 8.1 to 10.2%), 15%in smokers (95% CI, 12.8 to 17.1%), 12.8% in ex-smokers (95% CI,10.7 to 14.8%), and 4.1% in nonsmokers (95% CI, 3.3 to 5.1%). Theprevalence in men was 14.3% (95% CI, 12.8 to 15.9%) and 3.9% inwomen (95% CI, 3.1 to 4.8%). Marked differences were observed betweensexes in smoking; the percentage of nonsmokers was 23% in men and76.3% in women (p < 0.0001). The prevalence of COPD varied amongthe areas, ranging from 4.9% (95% CI, 3.2 to 7.0%) in the area of the lowest prevalence to 18% (95% CI, 14.8 to 21.2%) in the area of the highest. There was no previous diagnosis of COPD in 78.2% of cases(284 of 363). Only 49.3% of patients with severe COPD, 11.8% of patients with moderate COPD, and 10% of patients with mild COPD werereceiving some kind of treatment for COPD. Multivariate analysis showedthat individuals had a higher probability of having received a previousdiagnosis of COPD if they lived in urban areas, were of male gender, were > 60 years old, had higher educational levels, had > 15pack-year smoking history, or had symptoms of chronicbronchitis. Conclusions: COPD is a veryfrequent disease in Spain, and presents significant geographicvariations and a very low level of previous diagnosis and treatment, even in the most advanced cases. To ascertain the prevalence, diagnostic level, and treatment of COPD in Spain through a multicenterstudy comprising seven different geographic are as. This is an epidemiologic, multicenter, population-based study conducted in seven are as of Spain. A total of4,035 men and women (age range, 40 to 69 years) who were randomlyselected from a target population of 236,412 subjects participated inthe study. Eligible subjects answeredthe European Commission for Steel and Coal questionnaire. Spirometrywas performed, followed by a bronchodilator test when bronchialobstruction was present. The prevalence of COPD was 9.1% (95% confidence interval [CI], 8.1 to 10.2%), 15%in smokers (95% CI, 12.8 to 17.1%), 12.8% in ex-smokers (95% CI,10.7 to 14.8%), and 4.1% in nonsmokers (95% CI, 3.3 to 5.1%). Theprevalence in men was 14.3% (95% CI, 12.8 to 15.9%) and 3.9% inwomen (95% CI, 3.1 to 4.8%). Marked differences were observed betweensexes in smoking; the percentage of nonsmokers was 23% in men and76.3% in women (p < 0.0001). The prevalence of COPD varied amongthe areas, ranging from 4.9% (95% CI, 3.2 to 7.0%) in the area of the lowest prevalence to 18% (95% CI, 14.8 to 21.2%) in the area of the highest. There was no previous diagnosis of COPD in 78.2% of cases(284 of 363). Only 49.3% of patients with severe COPD, 11.8% of patients with moderate COPD, and 10% of patients with mild COPD werereceiving some kind of treatment for COPD. Multivariate analysis showedthat individuals had a higher probability of having received a previousdiagnosis of COPD if they lived in urban areas, were of male gender, were > 60 years old, had higher educational levels, had > 15pack-year smoking history, or had symptoms of chronicbronchitis. COPD is a veryfrequent disease in Spain, and presents significant geographicvariations and a very low level of previous diagnosis and treatment, even in the most advanced cases.