TY - JOUR
T1 - Altitude and COPD prevalence
T2 - Analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study
AU - the BOLD Collaborative Research Group, the EPI-SCAN Team, the PLATINO Team and the PREPOCOL Study Group
AU - Horner, Andreas
AU - Soriano, Joan B.
AU - Puhan, Milo A.
AU - Studnicka, Michael
AU - Kaiser, Bernhard
AU - Vanfleteren, Lowie E.G.W.
AU - Gnatiuc, Louisa
AU - Burney, Peter
AU - Miravitlles, Marc
AU - García-Rio, Francisco
AU - Ancochea, Julio
AU - Menezes, Ana M.
AU - Perez-Padilla, Rogelio
AU - Montes de Oca, Maria
AU - Torres-Duque, Carlos A.
AU - Caballero, Andres
AU - González-García, Mauricio
AU - Buist, Sonia
AU - Flamm, Maria
AU - Lamprecht, Bernd
N1 - Funding Information:
The initial BOLD (Burden of Obstructive Lung Disease) program was funded in part by unrestricted educational grants to the coordinating Centre in Portland, USA from Aventis, AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Merck, Novartis, Pfizer, Schering-Plough, Sepracor and University of Kentucky. The BOLD Study is currently funded by a grant from The Wellcome Trust (085790/Z/08/Z), which supports the London, UK Co-ordinating Centre. Additional local support for BOLD sites was provided by: Boehringer Ingelheim China (GuangZhou, China); Turkish Thoracic Society, Boehringer-Ingelheim, and Pfizer (Adana, Turkey); Altana, Astra-Zeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Sharpe & Dohme, Novartis, Salzburger Gebietskrankenkasse and Salzburg Local Government (Salzburg, Austria); Research for International Tobacco Control, the International Development Research Centre, the South African Medical Research Council, the South African Thoracic Society GlaxoSmithKline Pulmonary Research Fellowship, and the University of Cape Town Lung Institute (Cape Town, South Africa); Landspítali-University Hospital-Scientific Fund, GlaxoSmithKline Iceland, and AstraZeneca Iceland (Reykjavik, Iceland); GlaxoSmithKline Pharmaceuticals, Polpharma, Ivax Pharma Poland, AstraZeneca Pharma Poland, ZF Altana Pharma, Pliva Kraków, Adamed, Novartis Poland, Linde Gaz Polska, Lek Polska, Tarchomińskie Zakłady Farmaceutyczne Polfa, Starostwo Proszowice, Skanska, Zasada, Agencja Mienia Wojskowego w Krakowie, Telekomunikacja Polska, Biernacki, Biogran, Amplus Bucki, Skrzydlewski, Sotwin, and Agroplon (Krakow, Poland); Boehringer-Ingelheim, and Pfizer Germany (Hannover, Germany); the Norwegian Ministry of Health’s Foundation for Clinical Research, and Haukeland University Hospital’s Medical Research Foundation for Thoracic Medicine (Bergen, Norway); AstraZeneca, Boehringer-Ingelheim, Pfizer, and GlaxoSmithKline (Vancouver, Canada); Marty Driesler Cancer Project (Lexington, Kentucky, USA); Altana, Boehringer Ingelheim (Phil), GlaxoSmithKline, Pfizer, Philippine College of Chest Physicians, Philippine College of Physicians, and United Laboratories (Phil) (Manila, Philippines); Air Liquide Healthcare P/L, AstraZeneca P/L, Boehringer Ingelheim P/L, GlaxoSmithKline Australia P/L, Pfizer Australia P/L (Sydney, Australia), Department of Health Policy Research Programme, Clement Clarke International (London, United Kingdom); Boehringer Ingelheim and Pfizer (Lisbon, Portugal); Swedish Heart and Lung Foundation, The Swedish Association against Heart and Lung Diseases, Glaxo Smith Kline (Uppsala, Sweden); GlaxoSmithKline, Astra Zeneca, Eesti Teadusfond (Estonian Science Foundation) (Tartu, Estonia); AstraZeneca, CIRO HORN (Maastricht, The Netherlands); Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K (Srinagar, India); Foundation for Environmental Medicine, Kasturba Hospital, Volkart Foundation (Mumbai, India); Boehringer Ingelheim (Sousse, Tunisia); Philippines College of Physicians, Philippines College of Chest Physicians, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Orient Euro Pharma, Otsuka Pharma, United Laboratories Phillipines (Nampicuan, Philippines); National Heart and Lung Institute, Imperial College, London (Pune, India); The Wellcome Trust, National Population Commission, Ile-Ife, Osun State, Nigeria (Ile-Ife, Nigeria). The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was funded by Boehringer Ingelheim GmbH. The Epidemiologic Study of COPD in Spain (EPI-SCAN) study was funded by an unrestricted grant from GlaxoSmithKline Spain. The Prevalence Study of COPD in Colombia (PREPOCOL) was sponsored by an educational contribution from the Colombian offices of Boehringer Ingelheim GmbH and Pfizer Inc. (Bogotá, Colombia). Apart from the financial support for the original studies mentioned above, no further funding was provided for the current work. The sponsors of the different and pooled epidemiological studies played no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/8/23
Y1 - 2017/8/23
N2 - Background: COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors. Methods: A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD. Results: Among 30,874 participants aged 56.1±11.3years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p<0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude. Conclusion: Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.
AB - Background: COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors. Methods: A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD. Results: Among 30,874 participants aged 56.1±11.3years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p<0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude. Conclusion: Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.
KW - COPD
KW - Epidemiology
KW - Geographical altitude
KW - Risk factors
KW - Underdiagnosis
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U2 - 10.1186/s12931-017-0643-5
DO - 10.1186/s12931-017-0643-5
M3 - Article
C2 - 28835234
AN - SCOPUS:85028326343
VL - 18
JO - Respiratory Research
JF - Respiratory Research
SN - 1465-9921
IS - 1
M1 - 162
ER -