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Davies Adeloye, Peige Song, Yajie Zhu, Harry Campbell, Aziz Sheikh, Igor Rudan
Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Lancet Respir Med. 2022 May;10(5):447-458. doi: 10.1016/S2213-2600(21)00511-7. Epub 2022 Mar 10.
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.
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; FEV/FVC<0·7) and the lower limit of normal (LLN; FEV/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.
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/m (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.
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.
National Institute for Health Research and Health Data Research UK.
慢性阻塞性肺疾病（COPD）是全球发病率、残疾率和死亡率日益上升的重要原因。我们旨在评估全球、区域和国家 COPD 的患病率和危险因素，以指导政策和人群干预。
在这项系统评价和建模研究中，我们检索了 MEDLINE、Embase、全球健康和 CINAHL，以获取 1990 年 1 月 1 日至 2019 年 12 月 31 日发表的基于人群的 COPD 患病率研究。我们纳入了使用以下两种主要病例定义报告的数据：全球慢性阻塞性肺病倡议固定比值（GOLD；FEV/FVC<0.7）和正常值下限（LLN；FEV/FVC<LLN）。我们采用多水平多变量混合效应荟萃回归方法，根据世界银行的定义，为高收入国家（HICs）和低收入和中等收入国家（LMICs）生成 2019 年年龄和性别特异性 COPD 患病率。使用随机效应荟萃分析评估了 GOLD-COPD 的常见危险因素。
我们确定了 162 篇文章，这些文章报道了在 65 个国家的 260 个地点进行的基于人群的研究。2019 年，使用 GOLD 病例定义，全球 30-79 岁人群中 COPD 的患病率为 10.3%（95%CI 8.2-12.8），换算为 3.919 亿人（95%CI 3.126-4.879），使用 LLN 定义，患病率为 7.6%（5.8-10.1），换算为 2.920 亿人（2.198-3.856）。使用 GOLD 定义，我们估计全球 30-79 岁人群中有 3.919 亿人（95%CI 3.126-4.879）患有 COPD，其中大多数（3.155 亿人[2.467-3.996]；80.5%）生活在 LMICs。30-79 岁人群中 GOLD-COPD 的总体患病率在西太平洋地区最高（11.7%[95%CI 9.3-14.6]），在美洲地区最低（6.8%[95%CI 5.6-8.2]）。全球范围内，男性（OR 2.1[95%CI 1.8-2.3]）、吸烟（当前吸烟者 3.2[2.5-4.0]；曾经吸烟者 2.3[2.0-2.5]）、体重指数低于 18.5 kg/m2（2.2[1.7-2.7]）、生物质暴露（1.4[1.2-1.7]）和职业性粉尘或烟雾暴露（1.4[1.3-1.6]）都是 COPD 的重要危险因素。
由于全球 COPD 病例中有超过四分之三发生在 LMICs，因此在这些环境中应对这种慢性疾病是对卫生系统的重大和日益增加的挑战。在这些资源匮乏的国家，没有针对人口的广泛努力和卫生系统改革的情况下，在全球范围内实现 COPD 负担的大幅减轻可能仍然是一项艰巨的任务。
英国国家卫生研究所和英国健康数据研究中心。
