Prevalence and Population-Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study
Authors: Peter Burney, Jaymini Patel, Cosetta Minelli, Louisa Gnatiuc, André F. S. Amaral, Ali Kocabaş, Hamid Hacene Cherkaski, Amund Gulsvik, Rune Nielsen, Eric Bateman, Anamika Jithoo, Kevin Mortimer, Talant M. Sooronbaev, Hervé Lawin, Chakib Nejjari, Mohammed Elbiaze, Karima El Rhazi, Jin-Ping Zheng, Pixin Ran, Tobias Welte, Daniel Obaseki, Gregory Erhabor, Asma Elsony, Nada Bakri Osman, Rana Ahmed, Ewa Nizankowska-Mogilnicka, Filip Mejza, David M. Mannino, Cristina Bárbara, Emiel F. M. Wouters, Luisito F. Idolor, Li-Cher Loh, Abdul Rashid, Sanjay Juvekar, Thorarinn Gislason, Mohamed Al Ghobain, Michael Studnicka, Imed Harrabi, Meriam Denguezli, Parvaiz A. Koul, Christine Jenkins, Guy Marks, Rain Jõgi, Hasan Hafizi, Christer Janson, Wan C. Tan, Althea Aquart-Stewart, Bertrand Mbatchou, Asaad Ahmed Nafees, Kirthi Gunasekera, Terry Seemungal, Mahesh Padukudru Anand, Paul Enright, William M. Vollmer, Marta Blangiardo, Fadlalla G. Elfadaly, A. Sonia Buist, Hasan Hafizi, Anila Aliko, Donika Bardhi, Holta Tafa, Natasha Thanasi, Arian Mezini, Alma Teferici, Dafina Todri, Jolanda Nikolla, Rezarta Kazasi, Hamid Hacene Cherkaski, Amira Bengrait, Tabarek Haddad, Ibtissem Zgaoula, Maamar Ghit, Abdelhamid Roubhia, Soumaya Boudra, Feryal Atoui, Randa Yakoubi, Rachid Benali, Abdelghani Bencheikh, Nadia Ait-Khaled, Christine Jenkins, Guy Marks, Tessa Bird, Paola Espinel, Kate Hardaker, Brett Toelle, Michael Studnicka, Torkil Dawes, Bernd Lamprecht, Lea Schirhofer, Akramul Islam, Syed Masud Ahmed, Shayla Islam, Qazi Shafayetul Islam, Tridib Roy Chowdhury, Sukantha Kumar Chatterjee, Dulal Mia, Shyamal Chandra Das, Mizanur Rahman, Nazrul Islam, Shahaz Uddin, Nurul Islam, Luiza Khatun, Monira Parvin, Abdul Awal Khan, Maidul Islam, Herve Lawin, Arsene Kpangon, Karl Kpossou, Gildas Agodokpessi, Paul Ayelo, Benjamin Fayomi, Bertrand Mbatchou, Atongno Humphrey Ashu, Wan C. Tan, Wen Wang, NanShan Zhong, Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jin-ping Zheng, Yumin Zhou, Rain Jõgi, Hendrik Laja, Katrin Ulst, Vappu Zobel, Toomas-Julius Lill, Ayola Akim Adegnika, Tobias Welte, Isabelle Bodemann, Henning Geldmacher, Alexandra Schweda-Linow, Thorarinn Gislason, Bryndis Benedikdtsdottir, Kristin Jörundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, Gunnar Gudmundsson, Mahesh Rao, Parvaiz A. Koul, Sajjad Malik, Nissar A. Hakim, Umar Hafiz Khan, Rohini Chowgule, Vasant Shetye, Jonelle Raphael, Rosel Almeda, Mahesh Tawde, Rafiq Tadvi, Sunil Katkar, Milind Kadam, Rupesh Dhanawade, Umesh Ghurup, Sanjay Juvekar, Siddhi Hirve, Somnath Sambhudas, Bharat Chaidhary, Meera Tambe, Savita Pingale, Arati Umap, Archana Umap, Nitin Shelar, Sampada Devchakke, Sharda Chaudhary, Suvarna Bondre, Savita Walke, Ashleshsa Gawhane, Anil Sapkal, Rupali Argade, Vijay Gaikwad, Sundeep Salvi, Bill Brashier, Jyoti Londhe, Sapna Madas, Althea Aquart-Stewart, Akosua Francia Aikman, Talant M. Sooronbaev, Bermet M. Estebesova, Meerim Akmatalieva, Saadat Usenbaeva, Jypara Kydyrova, Eliza Bostonova, Ulan Sheraliev, Nuridin Marajapov, Nurgul Toktogulova, Berik Emilov, Toktogul Azilova, Gulnara Beishekeeva, Nasyikat Dononbaeva, Aijamal Tabyshova, Kevin Mortimer, Wezzie Nyapigoti, Ernest Mwangoka, Mayamiko Kambwili, Martha Chipeta, Gloria Banda, Suzgo Mkandawire, Justice Banda, Li-Cher Loh, Abdul Rashid, Siti Sholehah, Mohamed C. Benjelloun, Chakib Nejjari, Mohamed Elbiaze, Karima El Rhazi, E. F. M. Wouters, G. J. Wesseling, Daniel Obaseki, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Amund Gulsvik, Tina Endresen, Lene Svendsen, Asaad A. Nafees, Luisito F. Idolor, Teresita S. de Guia, Norberto A. Francisco, Camilo C. Roa, Fernando G. Ayuyao, Cecil Z. Tady, Daniel T. Tan, Sylvia Banal-Yang, Vincent M. Balanag, Maria Teresita N. Reyes, Renato. B. Dantes, Renato B. Dantes, Lourdes Amarillo, Lakan U. Berratio, Lenora C. Fernandez, Norberto A. Francisco, Gerard S. Garcia, Teresita S. de Guia, Luisito F. Idolor, Sullian S. Naval, Thessa Reyes, Camilo C. Roa, Ma. Flordeliza Sanchez, Leander P. Simpao, Ewa Nizankowska-Mogilnicka, Jakub Frey, Rafal Harat, Filip Mejza, Pawel Nastalek, Andrzej Pajak, Wojciech Skucha, Andrzej Szczeklik, Magda Twardowska, Cristina Bárbara, Fátima Rodrigues, Hermínia Dias, João Cardoso, João Almeida, Maria João Matos, Paula Simão, Moutinho Santos, Reis Ferreira, M. Al Ghobain, H. Alorainy, E. El-Hamad, M. Al Hajjaj, A. Hashi, R. Dela, R. Fanuncio, E. Doloriel, I. Marciano, L. Safia, Eric Bateman, Anamika Jithoo, Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, Janita Storbeck, Kirthi Gunasekera, Rajitha Wickremasinghe, Asma Elsony, Hana A. Elsadig, Nada Bakery Osman, Bandar Salah Noory, Monjda Awad Mohamed, Hasab Alrasoul Akasha Ahmed Osman, Namarig Moham ed Elhassan, Abdel Mu‘is El Zain, Marwa Mohamed Mohamaden, Suhaiba Khalifa, Mahmoud Elhadi, Mohand Hassan, Dalia Abdelmonam, Christer Janson, Inga Sif Olafsdottir, Katarina Nisser, Ulrike Spetz-Nyström, Gunilla Hägg, Gun-Marie Lund, Terence Seemungal, Fallon Lutchmansingh, Liane Conyette, Imed Harrabi, Myriam Denguezli, Zouhair Tabka, Hager Daldoul, Zaki Boukheroufa, Firas Chouikha, Wahbi Belhaj Khalifa, Ali Kocabaş, Attila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, Turgay Unalan, Peter G. J. Burney, Anamika Jithoo, Louisa Gnatiuc, Hadia Azar, Jaymini Patel, Caron Amor, James Potts, Michael Tumilty, Fiona McLean, Risha Dudhaiya, A. Sonia Buist, Mary Ann McBurnie, William M. Vollmer, Suzanne Gillespie, Sean Sullivan, Todd A. Lee, Kevin B. Weiss, Robert L. Jensen, Robert Crapo, Paul Enright, David M. Mannino, John Cain, Rebecca Copeland, Dana Hazen, Jennifer Methvin
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

Rationale: The Global Burden of Disease program identified smoking and ambient and household air pollution as the main drivers of death and disability from chronic obstructive pulmonary disease (COPD). Objectives: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged ≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a postbronchodilator FEV1-to-FVC ratio less than the lower limit of normal, and the relative risks associated with different risk factors. Local relative risks were estimated using a Bayesian hierarchical model borrowing information from across sites. From these relative risks and the prevalence of risk factors, we estimated local population attributable risks. Measurements and Main Results: The mean prevalence of CAO was 11.2% in men and 8.6% in women. The mean population attributable risk for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index, and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: Although smoking remains the most important risk factor for CAO, in some areas, poor education, low body mass index, and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.