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Published online before print April 12, 2006
Eur Respir J 2006, doi:10.1183/09031936.06.00124605
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ORIGINAL ARTICLE

Global burden of COPD: systematic review and meta-analysis

R.J. Halbert 1*, J.L. Natoli 2, Anacleto Gano 3, E. Badamgarav 3, A.S. Buist 4, D.M. Mannino 5

1 Cerner Health Insights, Beverly Hills, CA and Dept of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA
2 Cerner Health Insights, Beverly Hills, CA and Dept of Epidemiology, UCLA School of Public Health, Los Angeles, CA
3 Cerner Health Insights, Beverly Hills, CA
4 Dept of Pulmonary and Critical Care Medicine, Oregon Health and Science University
5 Dept of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY

* To whom correspondence should be addressed. E-mail: rhalbert{at}cerner.com.


  Abstract

To quantify the global prevalence of chronic obstructive pulmonary disease (COPD), we conducted a systematic review and random effects meta-analysis.

We searched MEDLINE for population-based prevalence estimates published from 1990-2004. Articles were included if they (1) provided total population or gender-specific estimates for COPD, chronic bronchitis (CB), and/or emphysema; and (2) had methods sufficiently clear to establish the sampling strategy, approach to diagnosis, and diagnostic criteria.

Of 67 accepted articles, 62 unique entries yielded 100 overall prevalence estimates from 28 different counties. The pooled prevalence for COPD was 7.5% (95% CI: 6.0%-9.2%) from 37 studies, 6.4% (5.3%-7.7%) for CB alone (38 studies), and 1.8% (1.3%-2.6%) for emphysema alone (8 studies). Pooled prevalence from 26 spirometric estimates was 8.9% (7.4%-10.7%). The most common spirometric definitions were those of the Global Initiative for Obstructive Lung Disease (GOLD, 12 estimates). There was statistically significant heterogeneity that was incompletely explained by subgroup analysis (eg, age, smoking status).

The prevalence of physiologically defined COPD in adults aged 40 years and older is approximately 9%-10%. There are important regional gaps, and methodological differences hinder interpretation of available data. The efforts of GOLD and similar groups should help standardize COPD prevalence measurement.

Keywords:  Chronic bronchitis, chronic obstructive pulmonary disease, emphysema, meta-analysis, prevalence, spirometry




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