Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study

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; BOLD Collaborative Research Group

doi:10.1164/rccm.202005-1990OC

Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study

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 WelteDaniel 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, BOLD Collaborative Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

72 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	1353-1365
Number of pages	13
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	203
Issue number	11
DOIs	https://doi.org/10.1164/rccm.202005-1990OC
Publication status	Published - 1 Jun 2021
Externally published	Yes

Keywords

Burden of Obstructive Lung Disease (BOLD) study
Chronic airflow obstruction
Multinational study
Population-attributable risk

Access to Document

10.1164/rccm.202005-1990OC

Cite this

Burney, P., Patel, J., Minelli, C., Gnatiuc, L., Amaral, A. F. S., Kocabaş, A., Cherkaski, H. H., Gulsvik, A., Nielsen, R., Bateman, E., Jithoo, A., Mortimer, K., Sooronbaev, T. M., Lawin, H., Nejjari, C., Elbiaze, M., El Rhazi, K., Zheng, J. P., Ran, P., ... BOLD Collaborative Research Group (2021). Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study. American Journal of Respiratory and Critical Care Medicine, 203(11), 1353-1365. https://doi.org/10.1164/rccm.202005-1990OC

@article{e770f295014f4b0eac5570b1c6332898,

title = "Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study",

abstract = "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.",

keywords = "Burden of Obstructive Lung Disease (BOLD) study, Chronic airflow obstruction, Multinational study, Population-attributable risk",

author = "Peter Burney and Jaymini Patel and Cosetta Minelli and Louisa Gnatiuc and Amaral, {Andr{\'e} F. S.} and Ali Kocaba{\c s} and Cherkaski, {Hamid Hacene} and Amund Gulsvik and Rune Nielsen and Eric Bateman and Anamika Jithoo and Kevin Mortimer and Sooronbaev, {Talant M.} and Herv{\'e} Lawin and Chakib Nejjari and Mohammed Elbiaze and {El Rhazi}, Karima and Zheng, {Jin Ping} and Pixin Ran and Tobias Welte and Daniel Obaseki and Gregory Erhabor and Asma Elsony and Osman, {Nada Bakri} and Rana Ahmed and Ewa Nizankowska-Mogilnicka and Filip Mejza and Mannino, {David M.} and Cristina B{\'a}rbara and Wouters, {Emiel F. M.} and Idolor, {Luisito F.} and Loh, {Li Cher} and Abdul Rashid and Sanjay Juvekar and Thorarinn Gislason and {Al Ghobain}, Mohamed and Michael Studnicka and Imed Harrabi and Meriam Denguezli and Koul, {Parvaiz A.} and Christine Jenkins and Guy Marks and Rain J{\~o}gi and Hasan Hafizi and Christer Janson and Tan, {Wan C.} and Althea Aquart-Stewart and Bertrand Mbatchou and Nafees, {Asaad Ahmed} and Kirthi Gunasekera and Terry Seemungal and Anand, {Mahesh Padukudru} and Paul Enright and Vollmer, {William M.} and Marta Blangiardo and Elfadaly, {Fadlalla G.} and Buist, {A. Sonia} and {BOLD Collaborative Research Group} and Anila Aliko and Donika Bardhi and Holta Tafa and Natasha Thanasi and Arian Mezini and Alma Teferici and Dafina Todri and Jolanda Nikolla and Rezarta Kazasi and Amira Bengrait and Tabarek Haddad and Ibtissem Zgaoula and Maamar Ghit and Abdelhamid Roubhia and Soumaya Boudra and Feryal Atoui and Randa Yakoubi and Rachid Benali and Abdelghani Bencheikh and Nadia Ait-Khaled and Tessa Bird and Paola Espinel and Kate Hardaker and Brett Toelle and Torkil Dawes and Bernd Lamprecht and Lea Schirhofer and Akramul Islam and Ahmed, {Syed Masud} and Shayla Islam and Islam, {Qazi Shafayetul} and Mesbah-Ul-Haque and Chowdhury, {Tridib Roy} and Chatterjee, {Sukantha Kumar} and Dulal Mia and Das, {Shyamal Chandra} and Mizanur Rahman and Nazrul Islam and Shahaz Uddin and Nurul Islam and Luiza Khatun and Monira Parvin and Khan, {Abdul Awal} and Maidul Islam and Arsene Kpangon and Karl Kpossou and Gildas Agodokpessi and Paul Ayelo and Benjamin Fayomi and Ashu, {Atongno Humphrey} and Wen Wang and Zhong, {Nan Shan} and Shengming Liu and Jiachun Lu and Dali Wang and Yumin Zhou and Hendrik Laja and Katrin Ulst and Vappu Zobel and Lill, {Toomas Julius} and Adegnika, {Ayola Akim} and Isabelle Bodemann and Henning Geldmacher and Alexandra Schweda-Linow and Bryndis Benedikdtsdottir and Kristin J{\"o}rundsdottir and Lovisa Gudmundsdottir and Sigrun Gudmundsdottir and Gunnar Gudmundsson and Mahesh Rao and Sajjad Malik and Hakim, {Nissar A.} and Khan, {Umar Hafiz} and Rohini Chowgule and Vasant Shetye and Jonelle Raphael and Rosel Almeda and Mahesh Tawde and Rafiq Tadvi and Sunil Katkar and Milind Kadam and Rupesh Dhanawade and Umesh Ghurup and Siddhi Hirve and Somnath Sambhudas and Bharat Chaidhary and Meera Tambe and Savita Pingale and Arati Umap and Archana Umap and Nitin Shelar and Sampada Devchakke and Sharda Chaudhary and Suvarna Bondre and Savita Walke and Ashleshsa Gawhane and Anil Sapkal and Rupali Argade and Vijay Gaikwad and Sundeep Salvi and Bill Brashier and Jyoti Londhe and Sapna Madas and Aikman, {Akosua Francia} and Estebesova, {Bermet M.} and Meerim Akmatalieva and Saadat Usenbaeva and Jypara Kydyrova and Eliza Bostonova and Ulan Sheraliev and Nuridin Marajapov and Nurgul Toktogulova and Berik Emilov and Toktogul Azilova and Gulnara Beishekeeva and Nasyikat Dononbaeva and Aijamal Tabyshova and Wezzie Nyapigoti and Ernest Mwangoka and Mayamiko Kambwili and Martha Chipeta and Gloria Banda and Suzgo Mkandawire and Justice Banda and Siti Sholehah and Benjelloun, {Mohamed C.} and Wesseling, {G. J.} and Olayemi Awopeju and Olufemi Adewole and Tina Endresen and Lene Svendsen and Muhammad Irfan and Zafar Fatmi and Aysha Zahidie and Natasha Shaukat and Meesha Iqbal and {de Guia}, {Teresita S.} and Francisco, {Norberto A.} and Roa, {Camilo C.} and Ayuyao, {Fernando G.} and Tady, {Cecil Z.} and Tan, {Daniel T.} and Sylvia Banal-Yang and Balanag, {Vincent M.} and Reyes, {Maria Teresita N.} and Dantes, {Renato B.} and Lourdes Amarillo and Berratio, {Lakan U.} and Fernandez, {Lenora C.} and Garcia, {Gerard S.} and Naval, {Sullian S.} and Thessa Reyes and Roa, {Camilo C.} and {Flordeliza Sanchez}, Ma and Simpao, {Leander P.} and Jakub Frey and Rafal Harat and Pawel Nastalek and Andrzej Pajak and Wojciech Skucha and Andrzej Szczeklik and Magda Twardowska and F{\'a}tima Rodrigues and Herminia Dias and Jo{\~a}o Cardoso and Jo{\~a}o Almeida and Matos, {Maria Jo{\~a}o} and Paula Sim{\~a}o and Moutinho Santos and Reis Ferreira and H. Alorainy and E. El-Hamad and {Al Hajjaj}, M. and A. Hashi and R. Dela and R. Fanuncio and E. Doloriel and I. Marciano and L. Safia and Desiree Adams and Edward Barnes and Jasper Freeman and Anton Hayes and Sipho Hlengwa and Christine Johannisen and Mariana Koopman and Innocentia Louw and Ina Ludick and Alta Olckers and Johanna Ryck and Janita Storbeck and Rajitha Wickremasinghe and Elsadig, {Hana A.}",

year = "2021",

month = jun,

day = "1",

doi = "10.1164/rccm.202005-1990OC",

language = "English",

volume = "203",

pages = "1353--1365",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "AMER THORACIC SOC",

number = "11",

}

Burney, P, Patel, J, Minelli, C, Gnatiuc, L, Amaral, AFS, Kocabaş, A, Cherkaski, HH, Gulsvik, A, Nielsen, R, Bateman, E, Jithoo, A, Mortimer, K, Sooronbaev, TM, Lawin, H, Nejjari, C, Elbiaze, M, El Rhazi, K, Zheng, JP, Ran, P, Welte, T, Obaseki, D, Erhabor, G, Elsony, A, Osman, NB, Ahmed, R, Nizankowska-Mogilnicka, E, Mejza, F, Mannino, DM, Bárbara, C, Wouters, EFM, Idolor, LF, Loh, LC, Rashid, A, Juvekar, S, Gislason, T, Al Ghobain, M, Studnicka, M, Harrabi, I, Denguezli, M, Koul, PA, Jenkins, C, Marks, G, Jõgi, R, Hafizi, H, Janson, C, Tan, WC, Aquart-Stewart, A, Mbatchou, B, Nafees, AA, Gunasekera, K, Seemungal, T, Anand, MP, Enright, P, Vollmer, WM, Blangiardo, M, Elfadaly, FG, Buist, AS & BOLD Collaborative Research Group 2021, 'Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study', American Journal of Respiratory and Critical Care Medicine, vol. 203, no. 11, pp. 1353-1365. https://doi.org/10.1164/rccm.202005-1990OC

TY - JOUR

T1 - Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study

AU - Burney, Peter

AU - Patel, Jaymini

AU - Minelli, Cosetta

AU - Gnatiuc, Louisa

AU - Amaral, André F. S.

AU - Kocabaş, Ali

AU - Cherkaski, Hamid Hacene

AU - Gulsvik, Amund

AU - Nielsen, Rune

AU - Bateman, Eric

AU - Jithoo, Anamika

AU - Mortimer, Kevin

AU - Sooronbaev, Talant M.

AU - Lawin, Hervé

AU - Nejjari, Chakib

AU - Elbiaze, Mohammed

AU - El Rhazi, Karima

AU - Zheng, Jin Ping

AU - Ran, Pixin

AU - Welte, Tobias

AU - Obaseki, Daniel

AU - Erhabor, Gregory

AU - Elsony, Asma

AU - Osman, Nada Bakri

AU - Ahmed, Rana

AU - Nizankowska-Mogilnicka, Ewa

AU - Mejza, Filip

AU - Mannino, David M.

AU - Bárbara, Cristina

AU - Wouters, Emiel F. M.

AU - Idolor, Luisito F.

AU - Loh, Li Cher

AU - Rashid, Abdul

AU - Juvekar, Sanjay

AU - Gislason, Thorarinn

AU - Al Ghobain, Mohamed

AU - Studnicka, Michael

AU - Harrabi, Imed

AU - Denguezli, Meriam

AU - Koul, Parvaiz A.

AU - Jenkins, Christine

AU - Marks, Guy

AU - Jõgi, Rain

AU - Hafizi, Hasan

AU - Janson, Christer

AU - Tan, Wan C.

AU - Aquart-Stewart, Althea

AU - Mbatchou, Bertrand

AU - Nafees, Asaad Ahmed

AU - Gunasekera, Kirthi

AU - Seemungal, Terry

AU - Anand, Mahesh Padukudru

AU - Enright, Paul

AU - Vollmer, William M.

AU - Blangiardo, Marta

AU - Elfadaly, Fadlalla G.

AU - Buist, A. Sonia

AU - BOLD Collaborative Research Group

AU - Aliko, Anila

AU - Bardhi, Donika

AU - Tafa, Holta

AU - Thanasi, Natasha

AU - Mezini, Arian

AU - Teferici, Alma

AU - Todri, Dafina

AU - Nikolla, Jolanda

AU - Kazasi, Rezarta

AU - Bengrait, Amira

AU - Haddad, Tabarek

AU - Zgaoula, Ibtissem

AU - Ghit, Maamar

AU - Roubhia, Abdelhamid

AU - Boudra, Soumaya

AU - Atoui, Feryal

AU - Yakoubi, Randa

AU - Benali, Rachid

AU - Bencheikh, Abdelghani

AU - Ait-Khaled, Nadia

AU - Bird, Tessa

AU - Espinel, Paola

AU - Hardaker, Kate

AU - Toelle, Brett

AU - Dawes, Torkil

AU - Lamprecht, Bernd

AU - Schirhofer, Lea

AU - Islam, Akramul

AU - Ahmed, Syed Masud

AU - Islam, Shayla

AU - Islam, Qazi Shafayetul

AU - Mesbah-Ul-Haque,

AU - Chowdhury, Tridib Roy

AU - Chatterjee, Sukantha Kumar

AU - Mia, Dulal

AU - Das, Shyamal Chandra

AU - Rahman, Mizanur

AU - Islam, Nazrul

AU - Uddin, Shahaz

AU - Islam, Nurul

AU - Khatun, Luiza

AU - Parvin, Monira

AU - Khan, Abdul Awal

AU - Islam, Maidul

AU - Kpangon, Arsene

AU - Kpossou, Karl

AU - Agodokpessi, Gildas

AU - Ayelo, Paul

AU - Fayomi, Benjamin

AU - Ashu, Atongno Humphrey

AU - Wang, Wen

AU - Zhong, Nan Shan

AU - Liu, Shengming

AU - Lu, Jiachun

AU - Wang, Dali

AU - Zhou, Yumin

AU - Laja, Hendrik

AU - Ulst, Katrin

AU - Zobel, Vappu

AU - Lill, Toomas Julius

AU - Adegnika, Ayola Akim

AU - Bodemann, Isabelle

AU - Geldmacher, Henning

AU - Schweda-Linow, Alexandra

AU - Benedikdtsdottir, Bryndis

AU - Jörundsdottir, Kristin

AU - Gudmundsdottir, Lovisa

AU - Gudmundsdottir, Sigrun

AU - Gudmundsson, Gunnar

AU - Rao, Mahesh

AU - Malik, Sajjad

AU - Hakim, Nissar A.

AU - Khan, Umar Hafiz

AU - Chowgule, Rohini

AU - Shetye, Vasant

AU - Raphael, Jonelle

AU - Almeda, Rosel

AU - Tawde, Mahesh

AU - Tadvi, Rafiq

AU - Katkar, Sunil

AU - Kadam, Milind

AU - Dhanawade, Rupesh

AU - Ghurup, Umesh

AU - Hirve, Siddhi

AU - Sambhudas, Somnath

AU - Chaidhary, Bharat

AU - Tambe, Meera

AU - Pingale, Savita

AU - Umap, Arati

AU - Umap, Archana

AU - Shelar, Nitin

AU - Devchakke, Sampada

AU - Chaudhary, Sharda

AU - Bondre, Suvarna

AU - Walke, Savita

AU - Gawhane, Ashleshsa

AU - Sapkal, Anil

AU - Argade, Rupali

AU - Gaikwad, Vijay

AU - Salvi, Sundeep

AU - Brashier, Bill

AU - Londhe, Jyoti

AU - Madas, Sapna

AU - Aikman, Akosua Francia

AU - Estebesova, Bermet M.

AU - Akmatalieva, Meerim

AU - Usenbaeva, Saadat

AU - Kydyrova, Jypara

AU - Bostonova, Eliza

AU - Sheraliev, Ulan

AU - Marajapov, Nuridin

AU - Toktogulova, Nurgul

AU - Emilov, Berik

AU - Azilova, Toktogul

AU - Beishekeeva, Gulnara

AU - Dononbaeva, Nasyikat

AU - Tabyshova, Aijamal

AU - Nyapigoti, Wezzie

AU - Mwangoka, Ernest

AU - Kambwili, Mayamiko

AU - Chipeta, Martha

AU - Banda, Gloria

AU - Mkandawire, Suzgo

AU - Banda, Justice

AU - Sholehah, Siti

AU - Benjelloun, Mohamed C.

AU - Wesseling, G. J.

AU - Awopeju, Olayemi

AU - Adewole, Olufemi

AU - Endresen, Tina

AU - Svendsen, Lene

AU - Irfan, Muhammad

AU - Fatmi, Zafar

AU - Zahidie, Aysha

AU - Shaukat, Natasha

AU - Iqbal, Meesha

AU - de Guia, Teresita S.

AU - Francisco, Norberto A.

AU - Roa, Camilo C.

AU - Ayuyao, Fernando G.

AU - Tady, Cecil Z.

AU - Tan, Daniel T.

AU - Banal-Yang, Sylvia

AU - Balanag, Vincent M.

AU - Reyes, Maria Teresita N.

AU - Dantes, Renato B.

AU - Amarillo, Lourdes

AU - Berratio, Lakan U.

AU - Fernandez, Lenora C.

AU - Garcia, Gerard S.

AU - Naval, Sullian S.

AU - Reyes, Thessa

AU - Roa, Camilo C.

AU - Flordeliza Sanchez, Ma

AU - Simpao, Leander P.

AU - Frey, Jakub

AU - Harat, Rafal

AU - Nastalek, Pawel

AU - Pajak, Andrzej

AU - Skucha, Wojciech

AU - Szczeklik, Andrzej

AU - Twardowska, Magda

AU - Rodrigues, Fátima

AU - Dias, Herminia

AU - Cardoso, João

AU - Almeida, João

AU - Matos, Maria João

AU - Simão, Paula

AU - Santos, Moutinho

AU - Ferreira, Reis

AU - Alorainy, H.

AU - El-Hamad, E.

AU - Al Hajjaj, M.

AU - Hashi, A.

AU - Dela, R.

AU - Fanuncio, R.

AU - Doloriel, E.

AU - Marciano, I.

AU - Safia, L.

AU - Adams, Desiree

AU - Barnes, Edward

AU - Freeman, Jasper

AU - Hayes, Anton

AU - Hlengwa, Sipho

AU - Johannisen, Christine

AU - Koopman, Mariana

AU - Louw, Innocentia

AU - Ludick, Ina

AU - Olckers, Alta

AU - Ryck, Johanna

AU - Storbeck, Janita

AU - Wickremasinghe, Rajitha

AU - Elsadig, Hana A.

PY - 2021/6/1

Y1 - 2021/6/1

N2 - 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.

AB - 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.

KW - Burden of Obstructive Lung Disease (BOLD) study

KW - Chronic airflow obstruction

KW - Multinational study

KW - Population-attributable risk

UR - http://www.scopus.com/inward/record.url?scp=85107550887&partnerID=8YFLogxK

U2 - 10.1164/rccm.202005-1990OC

DO - 10.1164/rccm.202005-1990OC

M3 - Article

C2 - 33171069

AN - SCOPUS:85107550887

SN - 1073-449X

VL - 203

SP - 1353

EP - 1365

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 11

ER -

Prevalence and population-attributable risk for chronic airflow obstruction in a large multinational study

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