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Chronic obstructive pulmonary disease: current burden and future projections

A. D. Lopez, K. Shibuya, C. Rao, C. D. Mathers, A. L. Hansell, L. S. Held, V. Schmid, S. Buist
European Respiratory Journal 2006 27: 397-412; DOI: 10.1183/09031936.06.00025805
A. D. Lopez
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K. Shibuya
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C. Rao
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C. D. Mathers
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A. L. Hansell
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L. S. Held
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V. Schmid
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S. Buist
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Figures

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  • Fig. 1—
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    Fig. 1—

    The World Health Organization mortality subregions used in the Global Burden of Disease 2000 Study. A: very low child and adult mortality; B: low child and adult mortality; C: low child mortality and high adult mortality; D: high child and adult mortality; E: high child mortality and very high adult mortality; AFR: Africa; AMR: Americas; EMR: Eastern Mediterranean; EUR: Europe; SEAR: South-East Asia; WPR: Western Pacific.

  • Fig. 2—
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    Fig. 2—

    Comparison of relative risks of chronic obstructive pulmonary disease-related mortality by age and sex for a) males and b) females. ▴: USA burden of disease study; •: Global Burden of Disease Study; ▪: model estimates.

  • Fig. 3—
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    Fig. 3—

    Estimated age-specific incidence for a) males and b) females, and age-specific prevalence for c) males and d) females of chronic obstructive pulmonary disease (COPD) by region, 2000. ▴: industrialised regions with very low child and adult mortality; ♦: Americas, combining the regions with low child and adult mortality, and high child and adult mortality; ▪: Europe, combining the regions with low child and adult mortality, and low child mortality and high adult mortality; ○: Eastern Mediterranean; □: South-East Asia; •: Western Pacific regions with low child and adult mortality; ⋄: Africa.

  • Fig. 4—
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    Fig. 4—

    Comparison of yrs lived with disability (YLD) per 1,000 for a) males and b) females in Global Burden of Disease (GBD) Study 1990 (□) and GBD 2000 (░) estimates. This figure compares results for 2000, using subregions, with results for 1990, where a different categorisation of subregions was used. EMR BD: Eastern Mediterranean, combining low child and adult mortality, and high child and adult mortality; AMR BD: Americas, combining the regions with low child and adult mortality, and high child and adult mortality, which corresponds to the 1990 categorisation of Latin America and the Caribbean; AFR: Africa; SEAR B + WPR B: this category comprises some of the South-East Asia region with low child and adult mortality, and two-thirds of the Western Pacific region with low child and adult mortality, which allows comparison with the 2000 estimates; SEAR D: South-East Asia region with high child and adult mortality, which corresponds to India; EUR BC: Europe, combining low child and adult mortality, and low child mortality and high adult mortality; A: industrialised regions.

  • Fig. 5—
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    Fig. 5—

    Chronic obstructive pulmonary disease mortality during the period of 1945–1999 in a) males and b) females aged ≥45 yrs in England and Wales (UK), unadjusted for International Classification of Disease (ICD) coding version changes (----: ICD change years). ▾: aged 45–54 yrs; ▴: aged 55–64 yrs; ▪: aged 65–74 yrs; ♦: aged 75–84 yrs; •: aged ≥85 yrs.

  • Fig. 6—
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    Fig. 6—

    Modelled and actual chronic obstructive pulmonary disease mortality rates per 1,000 for males (a–i) and females (j–r) in England and Wales for 1945–1999 and projected rates for 2000–2009 (----: cut-off line) for the following age groups: 45–49 yrs (a, j); 50–54 yrs (b, k); 55–59 yrs (c, l); 60–64 yrs (d, m); 65–69 yrs (e, n); 70–74 yrs (f, o); 75–79 yrs (g, p); 80–84 yrs (h, q); 85–89 yrs (i–r). Lines represent 5%, 25%, 50%, 75% and 95% centiles of modelled rates. Actual rates are represented by X.

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Tables

  • Figures
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  • Table 1—

    Estimated chronic obstructive pulmonary disease deaths and disability-adjusted life yrs (DALYs) by World Health Organization (WHO) region, 2002

    RegionDeaths thousandsDALYs thousands% of regional total DALYs
    AFR A525140.3
    AFR E656680.3
    AMR A14117433.7
    AMR B9014191.7
    AMR D101951.1
    SEAR B10014202.3
    SEAR D55667401.9
    EUR A14017443.4
    EUR B456731.8
    EUR C7610361.7
    EMR B153491.5
    EMR D809890.9
    WPR A214152.5
    WPR B135498204.0
    World2748277561.9
    • A: very low child and adult mortality; B: low child and adult mortality; C: low child mortality and high adult mortality; D: high child and adult mortality; E: high child mortality and very high adult mortality; AFR: Africa; AMR: Americas; SEAR: South-East Asia; EUR: Europe; EMR: Eastern Mediterranean; WPR: Western Pacific. The mortality strata (A–E) were used to distinguish groupings of countries likely to be at a similar level of health development among the member states of the WHO regions. Adapted from 7.

  • Table 2—

    Estimated differences in chronic obstructive pulmonary disease regional prevalence according to definition used for age groups≥30 yrs

    RegionPrevalence %
    SymptomsPhysician diagnosisSpirometry
    AFR D1–3
    AMR A5–151–32–5
    AMR B5–13
    EMR B2–101–2
    EUR A10–202–53–7
    EUR B10–20
    SEAR D2–7
    WPR A10–152–5
    WPR B2–81–3
    • Regions without prevalence studies have been omitted. A: very low child and adult mortality; B: low child and adult mortality; D: high child and adult mortality; AFR: Africa; AMR: Americas; EMR: Eastern Mediterranean; EUR: Europe; SEAR: South-East Asia; WPR: Western Pacific. See Supplementary material on website for information regarding the source of these data.

  • Table 3—

    Comparison of chronic obstructive pulmonary disease prevalence for those aged≥30 yrs by region, 1990 and 2000

    RegionCurrent 2000 estimates %Estimates based on GBD 1990 data %Published prevalence based on spirometry %
    MalesFemalesMalesFemalesMalesFemales
    AFR D1.10.52.41.4<1.0
    AFR E0.60.22.11.3
    AMR A4.03.21.40.73.0–5.02.0–4.0
    AMR B3.42.51.50.82.0–4.0
    AMR D0.70.31.40.7
    EMR B2.30.50.90.91.0–2.01.0
    EMR D1.81.00.90.9
    EUR A3.12.21.70.93.0–7.02.0–6.0
    EUR B1.71.21.70.93.0–8.02.0–5.0
    EUR C2.01.5¶¶
    SEAR B1.60.91.20.6
    SEAR D2.51.41.71.3<2.0<1.0
    WPR A2.92.01.91.02.0–4.02.0–3.0
    WPR B2.8#1.5#4.8#4.5#>3.0#<3.0#
    • GBD: Global Burden of Disease Study; A: very low child and adult mortality; B: low child and adult mortality; C: low child mortality and high adult mortality; D: high child and adult mortality; E: high child mortality and very high adult mortality; AFR: Africa; AMR: Americas; EMR: Eastern Mediterranean; EUR: Europe; SEAR: South-East Asia; WPR: Western Pacific. #: aged ≥15 yrs; ¶: included with EUR B.

  • Table 4—

    Estimates of yrs lived with disability(YLDs), yrs of life lost (YLLs) and disability-adjusted life yrs (DALYs) due to chronic obstructive pulmonary disease by region, 2000

    YLD·100000 males−1YLD·100000 females−1YLL·100000 males−1YLL·100000 females−1Total YLD thousandsTotal YLL thousandsTotal DALYs thousands
    AFR D49.811.2152.9136.1102482584
    AFR E47.111.5167.5131.999505603
    AMR A340.7270.3216.7202.29446481592
    AMR B179.0209.5134.592.98605021362
    AMR D159.495.473.690.29158149
    EMR B283.657.460.244.124473317
    EMR D123.158.6105.9100.3126142268
    EUR A265.0298.9198.6104.711606191779
    EUR B140.9175.340.927.834374418
    EUR C197.2265.6390.4132.35746221196
    SEAR B209.8171.3185.4118.67526001351
    SEAR D123.3123.0397.3353.7166050736733
    WPR A113.592.577.934.115483237
    WPR B236.295.4407.8493.8252467779628
    Total188.9140.1286.2260.999541654326497
    • A: very low child and adult mortality; B: low child and adult mortality; C: low child mortality and high adult mortality; D: high child and adult mortality; E: high child mortality and very high adult mortality; AFR: Africa; AMR: Americas; EMR: Eastern Mediterranean; EUR: Europe; SEAR: South-East Asia; WPR: Western Pacific.

  • Table 5—

    Comparison of predictions with actual total number of chronic obstructive pulmonary disease(COPD) plus asthma deaths for 1990–1999 in England and Wales in those aged ≥45 yrs

    Smoothing constraintData bridge-coded adjusted?% difference of sum of posterior median predictions from actual total number of deaths% of age-group categories where actual numbers lie within 25–75% centiles of predictions#% of age-group categories where actual numbers lie within 5–95% centiles of predictions#Square root of sum of posterior median predictive deviances
    COPD males
     RW1No+10.862.293.336.39
     RW1Yes+9.057.894.435.10
     RW2No+76.991.1100.0217.77
     RW2Yes+50.091.1100.0194.21
    COPD females
     RW1No+4.980.093.334.96
     RW1Yes+5.680.093.336.01
     RW2No+72.696.7100238.55
     RW2Yes+69.796.7100244.52
    • RW: random walk smoothing constraint. #: represents 90 cells, nine age-group categories over 10 yrs.

Additional Files

  • Figures
  • Tables
  • Supplementary material

    Files in this Data Supplement:

    • Adobe PDF - Final_Q_and_A_Global_Burden_of_COPD.pdf - This document summarizes the question and answer discussions related to the proceedings of a scientific workshop entitled The Global Burden of COPD, held in Vancouver, Canada, October 21-22, 2004.
    • Adobe PDF - Appendix1.pdf - Review of recent studies on COPD prevalence by WHO region.
    • Adobe PDF - Appendix2.pdf - Includes ICD codes used to define COPD and lung cancer and further information about Bayesian age-period-cohort statistical model.
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Chronic obstructive pulmonary disease: current burden and future projections
A. D. Lopez, K. Shibuya, C. Rao, C. D. Mathers, A. L. Hansell, L. S. Held, V. Schmid, S. Buist
European Respiratory Journal Feb 2006, 27 (2) 397-412; DOI: 10.1183/09031936.06.00025805

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Chronic obstructive pulmonary disease: current burden and future projections
A. D. Lopez, K. Shibuya, C. Rao, C. D. Mathers, A. L. Hansell, L. S. Held, V. Schmid, S. Buist
European Respiratory Journal Feb 2006, 27 (2) 397-412; DOI: 10.1183/09031936.06.00025805
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    • ESTIMATING THE BURDEN OF COPD: METHODS AND RESULTS FROM THE GLOBAL BURDEN OF DISEASE STUDY
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