BOLD研究：世界范围的COPD流行病学调查

世界范围的COPD流行病学调查：以人群为基础的普查
摘要
研究背景
COPD占全球总发病率和死亡率的比重日益增加。准确评价其流行病学需要预测COPD 的远期负担、关注主要危险因素和计划与COPD相关的健康服务措施。我们旨在调查COPD及其相关危险因素在不同国家、不同年龄性别和吸烟状态的变异。
Methods
Participants from 12 sites (n=9425) completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. COPD prevalence estimates based on the Global Initiative for Chronic Obstructive Lung Disease staging criteria were adjusted for the target population. Logistic regression was used to estimate adjusted odds ratios (ORs) for COPD associated with 10-year age increments and 10-pack-year (defined as the number of cigarettes smoked per day divided by 20 and multiplied by the number of years that the participant smoked) increments. Meta-analyses provided pooled estimates for these risk factors.

方法
12个地方的参与者（N=9425）除完成支气管的肺量测定外，还对其呼吸道症状、健康状态和暴露COPD的危险因素进行问卷调查。COPD普查标准是依照全球制定的COPD疾病分期标准，在目标人群中有所调整。以10岁为分段或10烟年（定义为每天吸的香烟支数除以20再乘以吸烟的年数）为分段，用Logistic回归来统计COPD的优势比的校正值。Meta分析被用于对这些危险因子进行汇总估计。

Findings
结果
The prevalence of stage II or higher COPD was 10•1% (SE 4•8) overall, 11•8% (7•9) for men, and 8•5% (5•8) for women.
在全部人群中，II期及以上的COPD的患病率是10.1%，其中在男性中患病率为11.8%.女性为8.5% 。

The ORs for 10-year age increments were much the same across sites and for women and men. The overall pooled estimate was 1•94 (95% CI 1•80–2•10) per 10-year increment. Site-specific pack-year ORs varied significantly in women (pooled OR=1•28, 95% CI 1•15–1•42, p=0•012), but not in men (1•16, 1•12–1•21, p=0•743).

优势比在不同地点男女每十年的增值基本相同。每十年的平均增值为1.94 (95% CI 1•80–2•10)。不同地方女性（共计OR=1•28, 95% CI 1•15–1•42, p=0•012）而不是男性(1•16, 1•12–1•21, p=0•743)的烟年胜算比的变异很大。

Interpretation
结论
This worldwide study showed higher levels and more advanced staging of spirometrically confirmed COPD than have typically been reported.
这项世界级的研究表明相对以前的报道，COPD有更高水平的发病率和处于晚期病程增多（通过肺活量计诊断）。
However, although age and smoking are strong contributors to COPD, they do not fully explain variations in disease prevalence—other factors also seem to be important.
然而，尽管年龄和香烟是COPD的强促进因素，但是它们不能完全解释发病的变异，也许其他因素也很重要。Although smoking cessation is becoming an increasingly urgent objective for an ageing worldwide population, a better understanding of other factors that contribute to COPD is crucial to assist local public-health officials in developing the best possible primary and secondary prevention policies for their regions.
虽然戒烟已成为一项对于全世界人口老化日益重要的紧急任务，但是更好了解其他促进COPD的危险因素，有助于帮助当地公共卫生官员为当地制定最可行的一级和二级预防政策。

Affiliations（附属机构）

a. Oregon Health and Sciences University, Portland, OR, USA
俄勒冈健康和科学大学，波特兰，俄勒冈州，美国
b. Kaiser Permanente Center for Health Research, Portland, OR, USA
凯撒永久健康研究中心，波特兰，俄勒冈州，美国
c. National Heart and Lung Institute, Imperial College, London, UK
国立心肺研究所 ，帝国大学，伦敦，英国
d. University of Kentucky, Lexington, KY, USA
肯塔基大学，列克基顿，肯塔吉州，美国
e. Federal University of Pelotas, Pelotas, Brazil
佩洛塔斯联邦大学，佩洛塔斯，巴西
f. University of Washington, Seattle, WA, USA
华盛顿大学，西雅图，华盛顿区，美国
g. Hines VA Hospital, Hines IL, USA
海因斯 VA医院，海因斯，依利诺斯州，美国
h. Northwestern University, Chicago, IL, USA
西北大学，芝加哥，依利诺斯州，美国
i. Latter Day Saints Hospital, Salt Lake City, UT, USA
基督教后期圣徒医院，盐湖城，犹他州，美国
j. Woolcock Institute of Medical Research, Sydney, Australia
奥而库克医学研究中心，悉尼，澳大利亚
k. University of Bergen, Bergen, Norway
培根大学，培根，挪威
l. Division of Pulmonary Diseases, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
雅盖隆大学医学部肺疾病区，克拉科夫，波兰