Aaron Shawn D, Gershon Andrea S, Gao Yuan, Yang Jenna, Whitmore G A
Ottawa Hospital Research Institute, University of Ottawa, Ottawa.
Sunnybrook Research Institute, University of Toronto, ON.
Int J Chron Obstruct Pulmon Dis. 2016 Sep 19;11:2305-2313. doi: 10.2147/COPD.S113868. eCollection 2016.
Studies suggest that COPD prevalence may vary between countries. We conducted an ecological study of data from COPD prevalence articles to assess the influence of differences in country-level risk factors on COPD prevalence.
Our study covered English language articles published during 2003-2014. Qualified articles used spirometry to assess COPD prevalence and used representative samples from national or subnational populations. Stepwise binomial regression was used to analyze associations between study- and country-level factors and COPD prevalence.
Eighty articles provided 1,583 measures of COPD prevalence for subjects in different sex, age, and smoking categories for 112 districts in 41 countries. Adjusted prevalence rates for COPD were significantly lower for Australia/New Zealand and the Mediterranean and significantly higher for Latin America, compared to North America, Southeast Asia, and Northern Europe. Country-level socioeconomic development variables had an uneven and mixed association with COPD prevalence. High elevation above sea level was shown to be a protective factor for COPD. Study-level variables for the established risk factors of sex, age, and smoking explained 64% of variability in COPD prevalence. Country-level risk factors raised the explanatory power to 72%. Approximately 28% of worldwide variability in COPD prevalence remained unexplained.
Our study suggests that COPD prevalence varies across world regions, even after adjustment for established risk factors. Major country-level risk factors contributing to the worldwide epidemic of COPD remain to be investigated.
研究表明慢性阻塞性肺疾病（COPD）的患病率在不同国家间可能存在差异。我们对COPD患病率相关文章的数据进行了一项生态学研究，以评估国家层面风险因素差异对COPD患病率的影响。
我们的研究涵盖了2003年至2014年期间发表的英文文章。符合条件的文章使用肺活量测定法评估COPD患病率，并采用来自国家或次国家层面人群的代表性样本。采用逐步二项式回归分析研究层面和国家层面因素与COPD患病率之间的关联。
80篇文章提供了41个国家112个地区不同性别、年龄和吸烟类别的受试者的1583项COPD患病率测量值。与北美、东南亚和北欧相比，澳大利亚/新西兰以及地中海地区的COPD调整患病率显著较低，而拉丁美洲则显著较高。国家层面的社会经济发展变量与COPD患病率的关联不均衡且复杂。海拔高度被证明是COPD的一个保护因素。性别、年龄和吸烟等既定风险因素的研究层面变量解释了COPD患病率64%的变异性。国家层面的风险因素将解释力提高到了72%。全球范围内约28%的COPD患病率变异性仍无法解释。
我们的研究表明，即使在对既定风险因素进行调整之后，COPD患病率在世界各地区仍存在差异。导致全球COPD流行的主要国家层面风险因素仍有待研究。
