review · BMC Public Health
A global systematic review and meta-analysis of forty-two spirometry-based studies assessed chronic obstructive pulmonary disease prevalence among individuals aged forty and older. The findings demonstrate that prevalence estimates vary substantially based on the diagnostic criteria applied. Under the fixed ratio definition, global prevalence reached 12.64 percent, with men experiencing significantly higher rates than women. Conversely, under the lower limit of normal definition, overall prevalence was 7.38 percent, with almost identical rates between sexes. Both criteria confirmed elevated prevalence among smokers and older populations, with stage two representing the most common disease severity. Geographical patterns also differed markedly depending on the measurement standard employed. Notably, the analysis identified a critical shortage of respiratory epidemiological data across the African and Eastern Mediterranean regions, underscoring the necessity for harmonised diagnostic standards and targeted prevention strategies to address the global disease burden.
Chronic obstructive pulmonary disease represents a major global health challenge, yet inconsistent diagnostic definitions create divergent pictures of who is affected. Demonstrating how diagnostic criteria alter prevalence figures across genders and regions enables public health organisations and healthcare planners to design more accurate screening programmes, target high-risk groups effectively, and address substantial data gaps in underserved parts of the world.
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major public health problem. The present study aims to provide a global and regional estimate of the prevalence of COPD based on spirometry according to the two most widely used diagnostic criteria of COPD: fixed ratio (FR) and lower limit of normal (LLN). METHODS: We conducted a systematic review of the literature according to PRISMA guidelines. MEDLINE, Web of Sciences, and Scopus databases were searched to identify studies on the spirometry-based prevalence of COPD in individuals aged 40 years and older. The meta-analysis was performed using MedCalc 19 software. RESULTS: In total, 42 of the 3393 studies reviewed were eligible for inclusion. The overall prevalence of COPD in people aged 40 years and older was 12.64% (95% CI 10.75%-14.65%) and 7.38% (95% CI 5.47% - 9.55%) based on FR and LLN criteria, respectively. By gender, men had a higher prevalence of COPD compared to women (15.47%; 95% CI 12.22%-19.02% for men versus 8.79%; 95% CI 6.94%-10.82% for women). Using the LLN criteria, the prevalence of COPD in both sexes was almost identical (8.67%; 95% CI 8.44%- 8.90% for men and 8.00%; 95% CI 6.42% - 9.73% for women). We reported a high prevalence of COPD among smokers and the elderly by both definitions of airway obstruction. Regional prevalence estimates using the FR definition indicate that the highest COPD prevalence was recorded in the Americas and the lowest was recorded in the Eastern Mediterranean region. Using the LLN definition, the highest prevalence was recorded in the Southeast Asian region and the lowest prevalence was recorded in the American region. The most common COPD stage was stage II, with a prevalence of 50.46%. The results indicate a huge lack of prevalence data in the African and Eastern Mediterranean region. The results were given using a random-effect model due to the high heterogeneity between studies. CONCLUSION: Results show that the prevalence of COPD differs according to the diagnostic criteria used. In addition, management and prevention strategies targeting risk factors for COPD are certainly needed to reduce the global burden of this chronic respiratory disease.
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DOI: 10.1186/s12889-024-17686-9
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