Epidemiology of chronic obstructive pulmonary disease: a literature review

Figures & data

Figure 1 PRISMA flow diagram of the literature review.

Notes: ^aIncludes studies in small numbers of patients, patients in very specific populations, patients who are hospitalized, patients with an existing condition that increases risk for COPD, and studies investigating risk factors for COPD.
Abbreviations: COPD, chronic obstructive pulmonary disease; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Table 1 COPD prevalence studies comparing multiple methods

Reference	Study design	Patient population (n)	Method	Prevalence (%) (overall and/or by sex, where available)	Prevalence (%), by age
Canada
Al-Hazmi et al^Citation11	Multicentre, two-stage study (six Canadian locations) to assess airflow obstruction (reversible = asthma, not entirely reversible = COPD).	21,449 randomly selected adults were sent ECRHS questionnaire, which 18,616 completed; of these, 2819 adults, aged 20–44 years, were screened in the laboratory.	LLN for FEV1/FVC (1999 method)	6.6 (M: 6.7; F: 6.5)	NR
			GOLD stage I^a (2001 method)	4.2	NR
			Self-reported CB	1.7	NR
Italy
Cricelli et al^Citation63,^b	Comparison of COPD prevalence from the HSD and the HIS6.^c	119,799 adults (aged ≥ 15 years).	Self-reported as being physician-diagnosed	M: 5.55 F: 4.45	See Supplementary materials, Table S3
	Prevalence rates age-standardized to overall population.	432,747 adults (aged ≥ 15 years).	COPD diagnosis of ICD-9 codes 491, 492, or 496, and a relevant prescription during study period	M: 4.03 F: 2.60	See Supplementary materials, Table S3
Viegi et al^Citation12	Two prospective cross-sectional surveys (in Po River Delta [1988–1991] and in Pisa [1991–1993]) plus spirometry.	Po River Delta: 2463 aged 36.3 years (range, 8–75 years).	Self-reported obstructive lung disease (CBE and/or asthma)	Po River Delta: 6.9 Pisa: 10.9	NR
		Pisa: 1890 aged 42.1 years (range, 8–75 years).	GOLD 2001 criteria^d	Po River Delta: 11.0 Pisa: 6.7	NR
Sweden
Lindberg et al^Citation4	Survey (mailed questionnaire) of random sample of adults (1992–1995).	4851 surveyed, 645 interviewed and had spirometry. Among those invited for examination, mean age was 49.1 years. Smokers: none, 45.3%; former, 28.2%; current, 26.5%.	BTS 1997 criteria^e	7.6 (M: 8.4; F: 6.8)	See Supplementary materials, Table S3
			GOLD 2001 criteria^d	14.1 (M: 15.3; F: 13.0)
			ATS 1986 guidelines^f	34.1 (M: 37.1; F: 31.2)
			ATS: clinical (CBE defined as a physician report or productive cough)	12.2 (M: 13.7; F: 10.8)
			ERS 1995 consensus statement^g	14.0 (M: 13.1; F: 14.8)
Lundbäck et al^Citation9 Lindberg et al^Citation8	Random sample of population-based survey respondents in 1996 were invited to screening interview and spirometry. Respondents were from OLIN 1st survey in 1985.	1237 aged 46–77 years. Smokers: (M) current, 24%; former, 47%; non, 29%. (F) current, 26%; former, 24%; non, 51%.	BTS 1997 criteria^e	8.1	See Supplementary materials, Table S3
			GOLD 2001 criteria^d	14.3
Montnémery et al^Citation64	Population-based survey, Malmö, Sweden (2000).	In 2000, questionnaire sent to 5179 randomly selected people aged 20–59 years. 3692 respondents. Smokers: (all) 28.4%; (M) 28.0%; (F) 28.1%.	Self-reported CBE or COPD from self-administered questionnaire	3.6 (M: 2.9; F: 4.2)	See Supplementary materials, Table S3
			Physician diagnosis of CBE/COPD	4.3	NR
UK
Shahab et al^Citation65	Study using data from HSE to describe prevalence of spirometry-defined COPD in England. Private households identified and members invited to participate. Prevalence rates age-standardized to overall population.	8215 aged > 35 years in HSE, with self-report data and valid spirometry. Mean age: 55.5 years. Smokers: current, 24.1%; ever, 55.1%.	ATS/ERS 2004 criteria^h	13.3	NR
			Self-reported CBE	1.1	NR
Soriano et al^Citation66	From a multicounty study: Retrospective analysis of UK GPRD, which records visits to a healthcare specialist (1998).	3 million inhabitants of England and Wales. Mean age: 37.6 years.	Patients coded with OXMIS and Read codes	CB: 0.5 Current emphysema: 0.5	Aged ≥ 50 years: Current CB: 1.1 Emphysema: 1.1
USA
Celli et al^Citation5	NHANES III (1988–1994) population-based survey. Included questionnaire, laboratory examination, and lung-function testing. Prevalence rates weighted to general US population.	9838 aged 30–80 years of Caucasian, non-Hispanic white, non-Hispanic black, or Mexican-American origin, with a satisfactory spirometry test.	Self-reported CBE	7.73 (M: 5.82; F: 9.55)	See Supplementary materials, Table S3
			GOLD stage I or higher (2001 criteria)	16.8 (M: 19.90; F: 13.83)
			GOLD stage IIA or higher (2001 criteria)	7.87 (M: 8.48; F: 7.29)
			ATS 1999 guidelines^i	14.2 (M: 15.00; F: 13.45)
			ERS 1995 guidelines^g	16.0 (M: 16.09; F: 15.92)
Celli et al^Citation13	NHANES III (1988–1994) population-based survey. Included questionnaire, laboratory examination, and lung-function testing. Prevalence rates weighted to general US population.	10,276 aged 30–80 years with satisfactory spirometry test.	GOLD stage I or higher (2004 guidelines)	Smokers: ever, 21.9; never, 9.12 (M: 10.06; F: 8.58)	See Supplementary materials, Table S3
		Smokers: ever, 5,732; never, 4,544.	Self-reported CBE	Smokers: ever, 10.0; never, 4.5	NR
Hnizdo et al^Citation14	Data from NHANES III in a working population (1988–1994). Included questionnaire, laboratory examination, lung-function testing. Prevalence rates weighted to general US population.	9823 aged 30–75 years. Excluded subjects with problems with lung-function tests, diagnosed current asthma, or missing occupational code.	GOLD stage II or higher (2001 criteria)	7.1 (M: 7.8; F: 6.1)	See Supplementary materials, Table S3
			Physician-diagnosed emphysema	1.6	NR
			Physician-diagnosed CB	4.5	NR
Hnizdo et al^Citation6	Retrospective analysis of data from population-based NHANES III (1988–1994). Included questionnaire and spirometry.	13,842 aged 20–80 years; Caucasian, African-American, or Mexican-American origin with spirometry data.	Self-reported CB	5.7	See Supplementary materials, Table S3
			Self-reported emphysema	1.8
			GOLD stage I (2001 criteria)	14.2
			GOLD stage II or higher (2001 criteria)	6.9
			LLN-1 (mild or greater severity [1991 ATS criteria])^j	12.3
			LLN-2 (moderate or greater severity [1991 ATS criteria])^k	6.2
Mannino et al^Citation67	Retrospective analysis of data from NHANES III (1988–1994). Prevalence rates weighted to general US population.	16,084 aged ≥ 17 years with lung-function testing. Mean age: 42.8 years; FEV1 predicted: 95.3%; FEV1/FVC ratio: 0.79.	Self-reported CB (current), asthma (current), or emphysema (ever) FEV1/FVC < 0.7; FEV1 > 80% predicted (ATS, 1995 criteria)	8.5	NR
				7.2	NR
				6.8	NR
			OLD stage 1 (ATS, 1995 criteria)^l	5.35	NR
			OLD stage 2 (ATS, 1995 criteria)^m OLD stage 3 (ATS, 1995 criteria)^n	1.45	NR
Mannino et al^Citation15	NHANES III, phase 2 (1991–1994). Prevalence rates age-adjusted to 2000 US population.	6600 noninstitutionalized adults aged ≥ 25 years with spirometry data.	Self-reported COPD	4.7	NR
			GOLD stage I (2001 criteria)	7.4	NR
			GOLD stage II and higher (2001 criteria)	8.0	NR
Methvin et al^Citation16	Survey including questionnaire and spirometry (study period NR). Prevalence estimates weighted to reflect target population.	508 noninstitutionalized adults aged ≥ 40 years, with completed questionnaires and pre- and postbronchodilator spirometry.	Self-reported COPD or CB	17.1	NR
			Self-reported emphysema	8.6	NR
			GOLD stage 0 (2001 criteria)^o	36.3 (M: 41.0; F: 32.4)	See Supplementary materials, Table S3
			GOLD stage I or higher (2007 criteria)	19.6 (M: 18.3; F: 20.8)
			Restricted	17.6 (M: 15.0; F: 19.9)
Soriano et al^Citation66	From a multicountry study: Retrospective analysis of NHANES III survey conducted in the USA, including questionnaire and spirometry (1988–1994).	33,994 noninstitutionalized subjects, of whom 22,431 had spirometry. Mean age: 34.3 years.	Self-reported physician diagnosis of CB (current), emphysema (ever), and asthma (current)	CB: 3.2 Emphysema: 1.5	Aged ≥ 50 years: Current CB: 5.8 Emphysema: 5.0
Vaz Fragoso et al^Citation7	Retrospective cohort study of subjects in the NHANES III (1988–1994); followed up until December 2000.	3502 white subjects aged 40–80 years with no self-reported asthma and acceptable spirometry data. Mean age: 60.7 years.	ATS/ERS-LLN5 (2005 criteria)	7.1	See Supplementary materials, Table S3
			GOLD stage I or higher (2007 criteria)	27.0
			LMS-LLN5 (2008 criteria)	13.8
Multicountry
Cerveri et al^Citation10	Self-completed questionnaire about respiratory health, followed by clinical assessment and spirometry in Belgium, Denmark, Germany, Spain, France, Ireland, Italy, The Netherlands, UK, Iceland, Norway, Sweden, Switzerland, New Zealand, the USA, and Australia (1991–1993).	17,966 aged 20–44 years. Of these, 14,819 had reliable FEV1 and FVC measurements.	Self-reported CB	3.2	NR
			ATS 1979 criteria^o	With CB: 8.4% No CB: 4.3%	NR

Notes:

a GOLD stage 1, FEV₁/FVC < 0.70; FVC predicted > 0.80.

b For Cricelli et al 2003,⁶³ prevalence values reported in this study were reported as prevalence per 1000 but have been translated to % (prevalence per 100) for consistency in this table.

c HSD, a computerized general-practice database; HIS6, a population-based survey.

d GOLD 2001 criteria, FEV₁/FVC < 0.70.

e BTS 1997 criteria, FEV₁/FVC < 0.70 and FEV₁< 80%.

f ATS 1986 guidelines, FEV₁/FVC < 0.75 (ATS, 1986).⁶⁸

g ERS 1995 consensus statement, FEV₁/FVC <88% predicted in men; <89% predicted in women (Siafakas et al 1995).⁶⁹

h ATS/ERS 2004 criteria, FEV₁/FVC < 0.70.

i ATS 1995 guidelines, FEV₁/FVC < LLN.

j LLN-1 (mild or greater severity), FEV₁/FVC < LLN; FEV₁ < 100% predicted (1991 ATS criteria).

k LLN-2 (moderate or greater severity), FEV₁/FVC < LLN; FEV₁ < LLN (∼ 80% predicted) (1991 ATS criteria).

l OLD stage 1 (FEV₁/FVC < 0.7; FEV₁ < 80% predicted) or higher (ATS, 1995 criteria).

m OLD stage 2 (FEV₁/FVC < 0.7; FEV₁ > 50% and < 80% predicted) (ATS, 1995 criteria).

n OLD stage 3 (FEV₁/FVC < 0.7; FEV₁ < 50% predicted) (ATS, 1995 criteria).

o GOLD stage 0 (symptoms of cough, sputum, wheeze, or breathlessness without airflow obstruction or restriction; 2001 criteria).

p ATS 1979 criteria, FEV₁/FVC < 0.70.

Abbreviations: ATS, American Thoracic Society; ATS/ERS-LLN₅, ATS/ERS defined LLN at the 5th percentile; BTS, British Thoracic Society; CB, chronic bronchitis; CBE, chronic bronchitis or emphysema; COPD, chronic obstructive pulmonary disease; ECRHS, European Community Respiratory Health Survey; ERS, European Respiratory Society; F, female; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; GPRD, General Practice Research Database; HSE, Health Survey for England; LLN, lower limit of normal; LMS, Lambda-mu-sigma; LMS-LLN₅, LMS defined LLN at the 5th percentile; M, male; NHANES, National Health and Nutrition Examination Survey; NR, not reported; OLD, obstructive lung disease; OLIN, obstructive lung disease in Northern Sweden; OXMIS, Oxford Medical Information Systems; UK, United Kingdom; US(A), United States (of America).

Table 2 Identified studies presenting data on incidence of COPD

Source, study name, study period	Study design	Patient characteristics (n)	Method for diagnosing COPD	Incidence (n)
Multicountry study
de Marco et al^Citation17 ECRHS II Study period: 1999–2002	Follow-up of patients in ECRHS I who completed respiratory health questionnaire, underwent clinical assessment, and spirometry, from 12 countries (Europe and the USA).^a Median follow-up: 8.9 years.	5002 without asthma, aged 20–44 years, with normal lung function,^b who participated in stage 2 of ECRHS I.	FEV1/FVC ≥ 70% at baseline (ECRHS I), and FEV1/FVC < 70% at end of follow-up (ECRHS II)	Cases per 1000 per year: All: 2.8; M: 3.2; F: 2.4 Aged 20–30 years: 1.5; 30–40 years: 2.6; 40–45 years: 4.7
Canada
Gershon et al^Citation18 NA Study period: 1991–2007	Population-based cohort from administrative health information system (2007).	7,082,086 in database population (denominator), 708,743 with COPD. Age: ≥35 years.	≥ 1 physician billing claims and/or ≥ 1 hospital discharges with diagnosis of COPD using ICD-9 codes 491, 492, 496; or ICD-10 codes J41, J42, J43, J44 Cases had to be >35 years when claim or discharge occurred	Cases per 1000 in 2007: All: 8.5; M: 9.4; F: 7.8 Aged 35–49 years: 4.4; 50–64 years: 8.8; Aged 65+ years: 17.9 Cases per 1000 in 1996, 2002, 2007 All: 11.8; 8.9; 8.5 M: 13.9; 10.1; 9.4 F: 10.4; 8.1; 7.8 Aged 35–49 years: 5.0; 3.9; 4.4 Aged 50–64 years: 11.5; 8.7; 8.8 Aged 65+ years: 28.5; 21.0; 17.9
Japan
Kojima et al^Citation19 NA Study period: April 1997 to March 2005	Large longitudinal study to estimate incidence of COPD.	17,106 aged 25–74. Mean: M, 47.7 years; F, 48.0 years.	Spirometry: GOLD stage I and higher	Cases per 100 person-years: All: M, 0.81; F, 0.31 M: Aged 25–29 years, 0.62; 30–34 0.31; 35–39 years, 0.35; 40–44 years, 0.47; 45–49 years, 0.61; 50–54 years: 1.05; 55–59 years, 1.25; 60–64 years: 1.67; 65–69 years, 2.75; 70–74 years, 4.95 F: Aged 25–29 years, 0.00; 30–34 years, 0.16; 35–39 years, 0.13; 40–44 years, 0.18; 45–49 years, 0.19; 50–54 years, 0.42; 55–59 years, 0.35; 60–64 years, 1.02; 65–69 years, 1.69; 70–74 years, 2.05
Sweden
Lindberg et al^Citation20 Study period: 1986–1996 OLIN	Survey in eight areas of northern Sweden. Those with symptoms were offered examination in 1986, then follow-up survey in 1996. 10% were lost to follow-up.	1986: 1506 interviewed and examined. 1996: 1109 with adequate spirometry.	BTS: FEV1/FVC < 0.70, FEV1< 80% GOLD: FEV1/FVC < 0.70	Cumulative incidence per 100 population over 10 years by BTS or GOLD spirometric criteria: BTS: All: 8.2; M: 9.0; F: 7.5 Born 1949–1950: 4.1; 1934–1935: 11.0; 1919–1920: 9.8 “Persistent” smoking 16.7; nonsmoking: 4.8 GOLD: All: 13.5; M: 15.3; F: 11.8 Born 1949–1950: 6.9; 1934–1935: 16.5; 1919–1920: 18.9 “Persistent” smoking: 24.5; nonsmoking: 9.4
Nihlen et al^Citation70 Study period: 2000	n = 4933 from a 1992 questionnaire,^c all aged 20–59 years in 1992.	4280 studied in 1992 and 2000. Smokers: Current, 32.8 (1992); 26.3 (2000). Former, 24.8 (1992); 30.7 (2000).	Self-reported physician’s diagnosis of COPD, CBE/COPD	Cumulative incidence per 100 population of self-reported CBE/COPD physician’s diagnoses between 1992 and 2000 (aged 28–67 years in 2000) Overall: 2.9 By age in 2000: 28–37 years, 1.9; 38–47 years, 2.9; 48–57 years, 2.5; 58–67 years: 4.2 By sex: M, 2.7; F, 3.1
Lindberg et al^Citation26 Study period: 1996–2003 OLIN	Ongoing population-based cohort with survey and subgroup invited for examination. (3rd update of OLIN cohort 1).	5189 surveyed in 1996. 963 with spirometry data were followed up in 1996 and 2003. Ever smoked: 59%. Mean FEV1% predicted: 97.45.	GOLD: Stage I–IV: FEV1/FVC < 0.70 GOLD II: Stage II–IV: FEV1/FVC < 0.70 and FEV1 < 80%	Cases per 100 population in 7 years: GOLD I–IV: Overall: 11.0; M: 9.7; F: 12.2 Age at entry: 46–47 years, 7.4; 61–62 years: 14.6, 76–77 years: 18.7 Smokers: non, 7.6; former, 10.5; current, 18.8 GOLD II–IV: Overall: 4.9; M: 4.4; F: 5.4 Age at entry: 46–47 years, 3.7; 61–62 years, 6.8; 76–77 years, 4.3 Smokers: non, 1.6; former, 5.2; current, 10.6
UK
García Rodríguez et al^Citation21 Study period: 1996	Cohort study in GPRD database. Followed by nested case-control study.	808,513 aged 40–89 years; 1-year prescription history and ≥ 2 years total enrolment; followed to end of 1996; no history of kyphoscoliosis, asthma, COPD, cancer, pulmonary fibrosis. Potential COPD cases = 2351.	Diagnoses in OXMIS and Read coding	Cases of COPD diagnosis per 1000 person-years: Overall: 2.6 (2.5–2.7) 40–49 years: M, 0.21; F, 0.26 50–59 years: M, 1.62; F, 1.16 60–69 years: M, 3.69; F, 1.82 70–79 years: M, 6.33; F, 3.37 80–89 years: M, 7.03; F, 3.46
Soriano et al^Citation71 Study period: 1990–1997 GPRD	Retrospective cohort study in UK GPRD data.	78,172 diagnosed with COPD 1990–1997. 50,174 incident COPD cases 1990–1997.	Diagnosed COPD found with OXMIS codes in general practitioner records	Incidence rate NR. Incident cases (50,714) counted for 1990–1997 and described. Severity of COPD based on type of drugs prescribed and whether oxygen was used. Severity defined for incident cases 1990–1997. Percentage of all incident cases of COPD in 1990–1997, by severity: Overall: mild, 35.5; moderate, 56.4; severe, 8.1 F: mild, 34.1; moderate, 57.7; severe, 8.2. M: mild, 36.7; moderate, 55.2; severe, 8.1
USA
Mannino et al^Citation15 Report of several surveys or studies conducted by the CDC’s NCHS	NAMCS to measure physician office visits (1980–2000); NHAMCS to measure hospital outpatient visits (1995–2000).	∼ 30,000 visits to physician’s office; ∼ 30,000 outpatient department encounters (in 2000).	COPD as first-listed diagnosis (ICD-9 code: 490–492, 496)	Incidence per 1000 population: All: 45.0; M: 46.8; F: 43.4 Aged 25–44 years: 17.7; 45–54 years: 31.9; 55–64 years: 46.3; 65–74 years: 119.9; ≥ 75 years: 125.7 Incidence per 1000 population over time: All: 1980, 44.5; 1985, 53.8; 1990, 67.6; 1995, 68.7; 1996, 58.6; 1997, 58.3; 1998, 81.6; 1999, 58.9; 2000, 45.0 M: 1980, 45.7; 1985, 57.4; 1990, 65.3; 1995, 74.2; 1996, 60.6; 1997, 62.5; 1998, 78.7; 1999, 51.9; 2000, 46.8 F: 1980, 37.8; 1985, 51.4; 1990, 68.6; 1995, 63.4; 1996, 56.7; 1997, 54.4; 1998: 84.5; 1999: 66.2; 2000: 43.4
Mannino et al^Citation15 Report of several surveys/studies conducted by the CDC’s NCHS	NHAMCS to measure emergency department visits (1992–2000).	∼ 30,000 emergency department encounters (in 2000).	COPD as first-listed diagnosis (ICD-9 code: 490–492, 496)	Incidence per 10,000 population: All: 87.2; M: 80.7; F: 94.4 Aged 25–44 years: 58.7; 45–54 years: 52.4; 55–64 years: 131.6; 65–74 years: 147.1; ≥ 75 years: 176.1 Incidence per 10,000 population over time: All: 1992, 67.6; 1995, 84.9; 1996, 72.7; 1997, 77.6; 1998, 82.6; 1999, 87.4; 2000, 87.2 M: 1992, 57.5; 1995, 90.0; 1996, 70.8; 1997, 4.1; 1998, 72.7; 1999, 93.0; 2000, 80.7 F: 1992, 76.6; 1995, 82.0; 1996, 75.9; 1997, 82.7; 1998, 93.1; 1999, 85.7; 2000, 94.4

Notes:

a 12 countries: Belgium, Estonia, France, Germany, Iceland, Italy, Norway, Spain, Sweden, Switzerland, the UK, and the USA.

b Normal lung function, FEV₁/FVC ≥ 70%.

c Appears to be a subset of patients in a Montnémery study published 1998; original 1992 sample was a population based in the Malmö area.

Abbreviations: BTS, British Thoracic Society; CBE, chronic bronchitis and emphysema; CDC, Centers for Disease Control and Prevention; COPD, chronic obstructive pulmonary disease; ECRHS, European Community Respiratory Health Survey; F, female; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, global obstructive lung disease initiative; GPRD, General Practice Research Database; ICD-9, International Classification of Diseases, 9th Revision; ICD-10, International Classification of Diseases, 10th Revision; M, male; NA, not applicable; NAMCS, National Ambulatory Medical Care Survey; NCHS, National Center for Health Statistics; NHAMCS, National Hospital Ambulatory Medical Care Survey; NR, not reported; OLIN, Obstructive Lung Disease in Northern Sweden; OXMIS, Oxford Medical Information Systems; UK, United Kingdom; USA, United States of America.

Table 3 Articles providing data allowing calculation of trends in COPD mortality in the overall population

Source, study name, study period	Study design	Patient characteristics (n)	Trends in mortality (by years)
Australia
Berend^Citation34 1921–1991 (Trends in mortality data are provided in the publication for 1979–1997 only)	Analysis of data collected by the ABS and presented by the AIHW.	Age: NR (all assumed). Sex (% F): NR. Disease severity: NR. Comorbidities: NR.	Trends in crude mortality rates for COPD per 100,000 population (interpreted from Figure 4 in the publication): M: 1979, 65; 1981, 65; 1983, 64; 1985, 58; 1987, 64; 1989, 65; 1991: 48; 1993: 47; 1995, 46; 1997, 38 F: 1979, 10; 1981, 12; 1983, 13; 1985, 16; 1987, 15; 1989, 18; 1991, 16; 1993, 17; 1995, 17; 1997, 15
Tan et al^Citation22 (1991–2004)	Retrospective analysis of mortality and hospitalization data from the Asia-Pacific region.^a	Data are presented only for the country of interest (ie, Australia). Adults aged ≥ 40 years (population size unknown).	Annual change in COPD mortality rates: 1991–2004: −3.6% (M: −5.1%; F: −1.4%) 1997–2004: −4.4% (M: −5.8%; F: −2.4%)
Canada
Stewart and McRae^Citation72 CCHS 1950–2002	Pop surveillance on COPD via the CCHS (2005).	Subjects aged ≥ 35 years participating in survey (population size unknown).	Age-standardized mortality rates from COPD (ICD-10 codes: J40–44) per 100,000 population (interpreted from Figure 1 in publication): 1950: 5; 1960: 9; 1970: 19; 1980: 22; 1990: 26; 2000: 26; 2003: 25
France
Fuhrman et al^Citation35 1979–2002	Mortality study using death cert data, 1979–1999 (ICD-9 codes), and 2000–2002 (ICD-10 codes).	Deaths reported in database during 1979–1999 and 2000–2002 in those aged ≥ 45 years (population size unknown).	Years	Mortality (mean annual age-standardized rates per 100,000 from COPD, M; F)
			1979–1981	81.6; 20.1
			1984–1986	85.6; 22.0
			1989–1991	75.6; 22.8
			1994–1996	74.0; 24.6
			1998–1999	75.4; 25.9
			% change, 1979–1999	−0.7%; +1.4%
USA
Day et al^Citation37 (1979–2003)	Retrospective analysis of NCI’s SEER program.	Alaskan natives (3404 deaths), US white residents, and Alaskan white residents.	Mortality rates (per 100,000 population) between 1979 and 2003 for Alaskan natives; US white residents: 1979–1983: 22.3; 29.8 1984–1988: 49.4; 35.8 1989–1993: 62.0; 39.2 1994–1998: 72.6; 42.2 1999–2003: 65.1; 45.8 Overall change in mortality rate between 1979 and 2003: Alaskan natives: 192%; US white residents: 54%
Day and Lanier^Citation36 (1979–1998)	Retrospective analysis of death certificates and Indian Health Service population estimates for the Alaskan native population.	∼ 91,300 Alaskan natives.	Mortality rates (per 100,000 population) between 1979 and 1998 for Alaskan natives: 1979–1983: 12.8; 1984–1988: 25.8; 1989–1993: 31.2; 1994–1998: 37.2 Mortality rates (per 100,000 population) between 1981 and 1996 for US white residents: 1981: 16.8; 1986: 19.3; 1991: 20.6; 1996: 21.5 Overall change in mortality rate: Alaskan natives: 191% between 1979 and 1983, and 1994 and 1998 US white residents: 28% between 1981 and 1996
Edwards et al^Citation38 (1980–2000)	Retrospective analysis of public mortality database, the CDC WONDER database.	Adults in Wisconsin aged ≥ 45 years (population size unknown).	Age-adjusted mortality rate (per 100,000 population) for COPD (ICD-10 J40–J44)
				1980	2000
			All; M; F	59; 112; 23	111; 150; 89
			45–54 years (M; F)	7.3; 2.6	4.5; 5.0
			55–64 years (M; F)	43; 14	29; 29
			65–74 years (M; F)	170; 4	180; 111
			75–84 years (M; F)	350; 58	478; 254
			>85 years (M; F)	484; 82	773; 334
Jemal et al^Citation73 (1970–2002)	Retrospective analysis of death certificates from NCHS.	Deaths in USA 1970–2002 (population size unknown).	Age-adjusted mortality rate (per 100,000 per years) from COPD (ICD-8 490–493, 519.3; ICD-9 490–496; ICD-10 J40–47): 1970: 21.4; 2002: 43.4 Change: 102.8%
Kazerouni et al^Citation40 (1968–1999)	Retrospective analysis of the national mortality files compiled by the CDC’s NCHS.	Deaths in the USA 1968–1999 (population size unknown).	Age-adjusted mortality rate (per 100,000 population) from COPD (ICD-8 490–492, 519; ICD-9 490–492, 496; ICD-10 J40–44), 1969 rate; 1999 rate; % increase: M: 35; 44; 27% F: 9; 41; 382%
Mannino et al^Citation15 Report of several surveys and studies conducted by CDC’s NCHS (1980–2000)	Retrospective analysis of the Mortality Component of the National Vital Statistics System to identify deaths due to COPD.	Adults aged ≥ 25 years.	Annual mortality from COPD (per 100,000 population): All: 1980, 40.7; 1985, 50.0; 1990, 53.3; 1995, 58.4; 1996, 59.3; 1997, 60.2; 1998, 61.3; 1999, 67.6; 2000, 66.9 M: 1980, 73.0; 1985, 81.9; 1990, 80.0; 1995, 78.9; 1996, 78.3; 1997, 79.0; 1998, 79.0; 1999, 85.9; 2000, 82.6 F: 1980, 20.1; 1985, 30.2; 1990, 37.0; 1995, 45.4; 1996, 47.2; 1997, 48.1; 1998, 49.9; 1999, 55.6; 2000, 56.7
Miller et al^Citation42 (1980–1996)	Retrospective analysis of death certificates from Missouri Center for Health Information Management and Epidemiology.	Subjects with deaths recorded in database.	Age-adjusted COPD mortality rate (per 100,000 per years), 1980–1996; 1990–1996; projected to 2006: All: 20.8; 22.6; 30.4 M: 30.2; 30.4; 32.5 F: 14.5; 17.5; 33.5
CDC^Citation43 (2000–2005)	Retrospective analysis of the CDC’s WONDER compressed mortality database of the National Vital Statistics System.	Adults aged ≥ 25 years.	Mortality rate (per 100,000 population) from COPD as underlying cause in 2000; 2001; 2002; 2003; 2004; 2005: All: 65.2; 64.7; 64.4; 64.3; 61.1; 64.3 M: 83.8; 81.3; 80.4; 78.7; 74.5; 77.3 F: 54.4; 54.7; 54.6; 55.4; 52.8; 56.0 25–44 years: 0.6; 0.7; 0.7; 0.7; 0.7; 0.7 45–54 years: 6.9; 6.9; 7.1; 7.1; 7.0; 7.9 55–64 years: 41.7; 41.7; 40.1; 41.0; 38.5; 40.1 65–74 years: 164.5; 163.5; 158.9; 159.5; 150.2; 157.2 ≥ 75 years: 439.7; 435.6; 440.6; 438.6; 419.2; 444.2
Singh and Hiatt^Citation45 NHIS	Retrospective analysis of NHIS data (1993–2003), national mortality database (1979–2001), and US census data (1980, 1990, 2000).	1980: 212,467,094 US-born (median age: 29.0 years); 14,079,906 foreign-born (37.0 years). 1990: 228,942,557 US-born (31.4 years); 19,767,316 foreign-born (37.3 years). 2000: 252,463,000 US-born (35.1 years); 33,471,000; foreign-born (38.4 years).	Annual age-adjusted mortality rates (per 100,000 population) for COPD (by ICD-9 and ICD-10 codes) in 1979–1981; 1989–1991; 1999–2000: M: US-born, 50.45; 57.25; 59.67 (18.28% change from 1979–2000) Foreign-born, 33.16; 35.45; 32.76 (−1.21% change from 1979–2000) F: US-born, 15.03; 27.81; 38.99 (159.41% change from 1979–2000) Foreign-born, 9.30; 16.09; 20.58 (121.29% change from 1979–2000)
Polednak^Citation74 (study in smokers)	Retrospective analysis of mortality data from NCI (1990–2009).	Adults aged ≥ 35 years in California; New Jersey and New York; the USA exclusive of California; and six tobacco-growing southern states.^b	Annual age-adjusted mortality rate (per 100,000 per years) for COPD (ICD-10 J40–47; ICD-9 490–496; ICD-8 490–493 and 519.3) in 1990; 2005: Age 35–64 years (all) California: 14.6; 11.5 (−21% change); all except California: 14.5; 14.1 (−3% change); New Jersey, New York: 12.3; 9.6 (−22% change); six southern states: 17.3; 17.3 (no change) Age ≥ 65 years (all) California: 281.4; 288.7 (3% change); all except California: 243.0; 299.8 (23% change); New Jersey, New York: 212.2; 225.4 (6% change); six southern states: 241.9; 329.4 (36% change)

Notes:

a Australia, Pacific Canada (British Columbia), Hong Kong, South Korea, and Taiwan.

b Kentucky, Georgia, North Carolina, South Carolina, Tennessee, and Virginia.

Abbreviations: ABS, Australian Bureau of Statistics; AIHW, Australian Institute of Health and Welfare; CCHS, Canadian Community Health Survey; CDC, Centers for Disease Control and Prevention; COPD, chronic obstructive pulmonary disease; F, female; ICD-9, International Classification of Diseases, 9th Revision; ICD-10, International Classification of Diseases, 10th Revision; M, male; NCI, National Cancer Institute; NCHS, National Center for Health Statistics; NHIS, National Health Interview Survey; NR, not reported; SEER, Surveillance Epidemiology and End Results; USA, United States of America; WONDER, Wide-ranging Online Data for Epidemiologic Research.

Table S1 Search strategy used for literature search

Search number	Search terms^a
COPD
#1	“Pulmonary Disease, Chronic Obstructive”[MeSH] OR “chronic obstructive pulmonary disease”[Text Word] OR “COPD”[Text Word] OR “Pulmonary Emphysema”[MeSH] OR “emphysema”[Text Word] OR “Bronchitis, Chronic”[MeSH] OR “chronic bronchitis”[Text Word]
Epidemiology data
#2	“Epidemiology”[MeSH] OR “Incidence”[MeSH] OR “Prevalence”[MeSH] OR “Cause of Death”[MeSH] OR (“Hospital Mortality”[MeSH] NOT “Hospital Mortality/ethnology”[MeSH]) OR “Morbidity”[MeSH]
#3	“Pulmonary Disease, Chronic Obstructive/epidemiology”[Majr] OR “Pulmonary Disease, Chronic Obstructive/mortality”[Majr] OR “Pulmonary Emphysema/epidemiology”[Majr] OR “Pulmonary Emphysema/mortality”[Majr] OR “Bronchitis, Chronic/epidemiology”[Majr] OR “Bronchitis, Chronic/mortality”[Majr] OR “Lung Diseases, Obstructive/epidemiology”[Majr:NoExp] OR “Lung Diseases, Obstructive/mortality”[Majr:NoExp]
#4	(#1 AND #2) OR #3
Exclusionary terms
#5	“Comment”[Publication Type] OR “Editorial” [Publication Type] OR “Letter”[Publication Type] OR “Case Reports”[Publication Type] OR “Clinical Trial”[Publication Type]
#6	“Animals”[MeSH] NOT “Humans”[MeSH]^b
Total
#7	#4 NOT (#5 OR #6)

Notes:

a Search limits: English language; and publication date from January 2000 to September 2010.

b NOT (“Animals”[MeSH] NOT “Humans”[MeSH]) excludes articles that have only the tag for animal studies. By using this approach instead of selecting the “humans” limitation in PubMed, recent articles that have not been fully indexed (including the “humans” tag) but that are exclusively in humans will not be excluded.

Abbreviations: COPD, chronic obstructive pulmonary disease; MeSH, Medical Subject Headings.

Table S2 Summary of articles included in literature review

Country	Number of articles reporting data types^a
	All articles	Multicountry articles	Prevalence	Incidence	Mortality
Multicountry studies	19	NA	12	2	7
Australia	4	4	2	1	6
Canada	12	4	13	2	6
France	2	4	3	0	3
Germany	1	4	4	0	1
Italy	3	5	7	0	2
Japan	6	2	5	1	2
The Netherlands	2	5	4	0	4
Spain	7	5	7	0	5
Sweden	19	4	14	4	7
The United Kingdom	9	5	11	2	4
The United States	49	6	29	4	30
Total	133	NA	80	15	58

Notes:

a All numbers reported in this table also include any multicountry studies that also provided separate data in the countries of interest. Therefore, a multicountry article could be counted more than once in each column.

Abbreviation: NA, not applicable.

Table S3 Articles reporting prevalence included in literature review

Reference	Study design	Population	Method	Population (n)	Age (years)	Prevalence (%)
Multicountry studies
Boutin-Forzano et al^Citation75	Questionnaire, conducted in eight European cities 2003–2004.	6915 subjects from 3373 homes across eight cities; 47.2% female. Mean age: 46.7 years.	CBE diagnosed and/or treated in the previous 12 months	6915	≥18	6.2
Buist et al^Citation76	Population-based study in 12 countries including questionnaire on respiratory symptoms and health status, and spirometry tests (data collection completed December 2006).	9425 subjects aged ≥ 40 years.	Spirometry: GOLD stage	9425	≥40	10.1
	Germany	49% female. Mean age: 57.3–58.5 years.	Spirometry: GOLD stage	683	≥40	M: 8.7; F: 3.7
					40–49	M: 0; F: 2.5
					50–59	M: 10.7; F: 2.9
					60–69	M: 8.9; F: 4.4
					≥70	M: 19.0; F: 6.2
	Canada	58% female. Mean age: 56.4–57.5 years.	Spirometry: GOLD stage	827	≥40	M: 9.3; F: 7.3
					40–49	M: 2.8; F: 1.3
					50–59	M: 6.4; F: 1.3
					60–69	M: 12.0; F: 10.8
					≥70	M: 26.2; F: 20.7
	USA	58% female. Mean age: 56.6–57.5 years.	Spirometry: GOLD stage	508	≥40	M: 12.7; F: 15.6
					40–49	M: 1.8; F: 5.1
					50–59	M: 17.9; F: 11.0
					60–69	M: 19.6; F: 25.6
					≥70	M: 19.2; F: 29.6
	Australia	50% female. Mean age: 57.6–59.9 years.	Spirometry: GOLD stage	541	≥40	M: 9.3; F: 12.2
					40–49	M: 2.7; F: 4.9
					50–59	M: 4.1; F: 6.8
					60–69	M: 13.8; F: 13.8
					≥70	M: 22.4; F: 23.8
Cerveri et al^Citation10	Self-completed questionnaire in 16 countries about respiratory health, followed by clinical assessment and spirometry (1991–1993).	17,966 subjects aged 20–44 years; of these, 14,819 with reliable FEV1 and FVC measurements.	Patient-reported chronic bronchitis	17,966	20–44	3.2
			Spirometry: ATS criteria	14,819	20–44	8.4 with chronic bronchitis; 4.3 without chronic bronchitis
Menotti et al^Citation77	Subset of the prospective cohort study, the Seven Countries Study, with follow-up 10 years after the study start: The Netherlands (1985–1995).	2285 men aged 65–84 years (716 in Finland, 887 in The Netherlands, 682 in Italy).	Productive cough for at least 3 months per year, and a clinical diagnosis by the examining physician	887	65–84	13.8
	Subset of the prospective cohort study, the Seven Countries Study, with follow-up 10 years after the study start: Italy (1985–1995).	2285 men aged 65–84 years (716 in Finland, 887 in The Netherlands, 682 in Italy).	Productive cough for at least 3 months per year, and a clinical diagnosis by the examining physician	682	65–84	22.8
Rennard et al^Citation78	International survey of eight countries to identify subjects who had been diagnosed with COPD and to quantify the burden of COPD (2000).	201,921 households.	Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	2.8
	Canada		Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	5.8
	France		Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	6.0
	Germany		Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	7.5
	Italy		Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	6.1
	The Netherlands		Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	8.6
	Spain		Subjects with ≥ 10 pack-years (cumulative cigarette consumption, based on cigarettes smoked per day and years of daily smoking), who had been diagnosed with COPD, emphysema or chronic bronchitis	201,921 households	≥45	5.8
Soriano et al^Citation66	Retrospective analysis of cross-sectional NHANES III survey conducted in the USA, including questionnaire and spirometry (1988–1994).	33,994 noninstitutionalized subjects, of whom 22,431 had spirometry. Mean age: 34.3 years.	Self-reported physician diagnosis of chronic bronchitis (current)	33,994	Mean: 34.3	3.2
					≥50	5.8
	Retrospective analysis of cross-sectional NHANES III survey conducted in the USA, including questionnaire and spirometry (1988–1994).	33,994 noninstitutionalized subjects, of whom 22,431 had spirometry. Mean age: 34.3 years.	Self-reported physician diagnosis of emphysema (ever)	33,994	Mean: 34.3	1.5
					≥50	5.0
	Retrospective analysis of the UK GPRD, which records visits to a health-care specialist (1998).	3 million inhabitants of England and Wales. Mean age: 37.6 years.	Patients coded with Oxford Medical Information System (OXMIS) and Read codes for chronic bronchitis	3 million	Mean: 37.6	0.5
					≥50	1.1
	Retrospective analysis of the UK GPRD, which records visits to a health care specialist (1998).	3 million inhabitants of England and Wales. Mean age: 37.6 years.	Patients coded with Oxford Medical Information System (OXMIS) and Read codes for emphysema	3 million	Mean: 37.6	0.5
					≥50	1.1
Svanes et al^Citation79	Self-completed questionnaire in 17 countries in Europe about adult respiratory health (study period not reported).	18,922 subjects aged 20–44 years from 37 centers.	Chronic bronchitis, defined as having both regular cough and phlegm	18,922	20–44	11
de Marco et al^Citation80	Self-completed questionnaire about respiratory health, followed by clinical assessment and spirometry in 35 centers in 16 countries (1991–1993).	18,412 subjects aged 20–44 years. Of these, 14,855 subjects completed the clinical interview and had at least two reliable FEV1 and FVC measurements.	Spirometry: GOLD stage 1 and higher	18,412	20–44	3.6
Canada
Al-Hazmi et al^Citation11	Multicentre, two-stage study (six Canadian locations) to assess airflow obstruction (reversible = asthma, not entirely reversible = COPD). 21,449 randomly selected adults were sent ECRHS questionnaire, which 18,616 completed. A random subset of 2819 adults was screened in laboratory.	2819 screened in laboratory; 54.0% female; aged 20–44 years.	Airflow obstruction, defined by the LLN for FEV1/FVC using Hankinson’s equations	2819	20–44	6.6
			Spirometry: GOLD stage 1	2819	20–44	4.2
			Self-reported chronic bronchitis	2819	20–44	1.7
Camp et al^Citation27	Analysis of the British Columbia MOH administrative health services databases.	1,708,418 subjects included in the MOH administrative databases, aged 45 years and older.	ICD-9 codes: 491, 492, 496	1,708,418	≥45	M: 4.7; F: 4.0
					45–64	M: 1.9; F: 1.6
					≥65	M: 10.8; F: 7.9
Gershon et al^Citation18	Population-based cohort fom administrative health information system (2007).	7,082,086 in database population (denominator), 708,743 with COPD; 51.8% female; aged ≥ 35 years	ICD-9 codes 491, 492, 496; ICD-10 codes J41, J42, J43, J44	7,082,086	≥35	9.5
					35–49	2.7
					50–64	10.2
					≥65	22.2
Lacasse et al^Citation81	Validity assessment of COPD diagnoses using a large administrative database (RAMQ) using data from the National Population Health Survey.	7.4 million people in RAMQ database.	ICD-9 codes 491, 492, and 496	7.4 million	45–54	2.5
					55–64	5.5
					65–74	10.7
					75+	17.8
			ICD-9 codes 490, 491, 492, and 496	7.4 million	45–54	13.7
					55–64	17.6
					65–74	23.1
					75+	31.2
Ohinmaa et al^Citation82	Analysis of CCHS data to determine health care costs associated with specific health behaviors among residents of Alberta.	2,133,413 non-First Nation, noninstitutionalized subjects residing in Alberta, aged ≥ 20 years.	Self-reported diagnosis of COPD	2,133,413	≥20	0.83
					20–44	0.12
					45–64	0.76
					≥65	2.90
Stewart and McRae^Citation83	Population surveillance on COPD via the CCHS (2005)	Subjects aged ≥ 35 years participating in the CCHS (population size unknown).	Self-reported diagnosis of COPD, chronic bronchitis, or emphysema	NA	≥35	4.4
				NA	≥75	All: 9.3
						M: 11.8; F: 7.5
Chen et al^Citation84	Population-based survey in all provinces of Canada.	19,600 households; COPD patients 52.6% female; aged 35–64 years.	Self-reported diagnosis of chronic bronchitis or emphysema	19,600 households	35–44	M: 1.8; 3.5
					45–54	M: 1.5; F: 3.6
					55–64	M: 5.0; F: 4.5
Hill et al^Citation85	Clinic-based assessment (interview and spirometry) of patients from three primary care sites to assess COPD prevalence.	Subjects with a smoking history of at least 20 pack-years; 47.4% female; aged ≥ 40 years. Mean age: 59.1 years.	Patient interview and spirometry: GOLD stage II and higher	1003 smokers	≥40	20.7
Vozoris et al^Citation86	Cross-sectional, population-based survey data were analyzed for second-hand smoke exposure and health variables (including COPD).	Aged ≥ 12 years. Never-smokers, 57.6% female; former smokers, 46.9% female.	Self-reported chronic bronchitis	48,540 never-smokers;	≥12	Never-smokers, 1.56;
				48,117 former smokers		Former smokers, 2.76
			Self-reported emphysema	48,540 never-smokers;	≥12	Never-smokers, 0.27;
				48,117 former smokers		Former smokers, 1.40
France
Huchon et al^Citation87	Population-based survey to determine the prevalence of symptoms indicative of chronic bronchitis.	n = 14,076 population sample; 54% female (M:F ratio, 0.85 :1) aged ≥25 years. Mean age: 51.1 years.	Patient-reported chronic bronchitis	14,076	≥25	4.1
Italy
Anecchino et al^Citation88	Cross-sectional study conducted using administrative health services databases from 22 Italian local health units participating in the ARNO project.	3,535,371 National Health System users; 126,283 patients with COPD; 47.8% female; aged ≥ 45 years.	Treatment with inhaled/oral bronchodilators, inhaled steroids, or fixed-dose combinations	3,535,371	≥45	3.6
					45–64	1.9
					65–74	4.8
					75–84	6.8
					≥85	5.6
Cricelli et al^Citation63	Comparison of COPD prevalence from the HSD, a computerized general-practice database, and the HIS6, a population-based survey.	HIS6: 119,799 adults; HSD: 432,747 adults.	Self-reported and physician-diagnosed COPD	119,799	≥15	M: 5.6; F: 2.6
					15–24	M: 0.9; F: 0.9
					25–34	M: 1.0; F: 0.9
					35–44	M: 1.6; F: 1.8
					45–54	M: 3.6; F: 3.3
					55–64	M: 8.1; F: 5.6
					65–69	M: 13.8; F: 7.3
					70–74	M: 17.6; F: 10.5
					75–79	M: 21.1; F: 12.0
					≥80	M: 25.2; F: 15.8
			A COPD diagnosis (ICD-9 codes 491, 492, 496) and a relevant prescription during the study period	432,747	≥15	M: 4.0; F: 2.6
					15–24	M: 1.1; F: 0.7
					25–34	M: 0.8; F: 0.8
					35–44	M: 1.4; F: 1.3
					45–54	M: 2.7; F: 2.0
					55–64	M: 5.7; F: 3.5
					65–69	M: 9.7; F: 4.6
					70–74	M: 12.7; F: 5.8
					75–79	M: 15.6; F: 6.4
					≥80	M: 14.9; F: 6.7
Viegi et al^Citation12	Two prospective cross-sectional surveys (one in Po River Delta and one in Pisa) plus spirometry.	Po River Delta: 2,463; 50.8% female. Mean age: 36.3 years (SD, 16.5; range, 8–75). Pisa: 1,890; 49.6% female. Mean age: 42.1 years (SD, 17.5; range, 8–75).	Self-reported obstructive lung disease (chronic bronchitis, emphysema, and/or asthma)	Po River Delta: 2,463; Pisa: 1,890	Po River Delta: mean 36.3 (range, 8–75) Pisa: mean 42.1 (range, 8–75)	Po River Delta: 6.9 Pisa: 10.9
Japan
Fukahori et al^Citation89	Prospective, clinic-based study.	n = 1424; 46.5% female; aged ≥40 years. Mean age: 66.0 years.	Spirometry (GOLD stage I and higher)	1424	≥40	13.6
Fukuchi et al^Citation90	A retrospective study conducted in 18 (out of 47) Japanese prefectures, representing 49% of the Japanese population.	2343 patients; 48% female. Mean age: 58 years. Disease severity (mean): FEV1, 2.68; FVC, 3.41. FEV1/FVC: 78.67%.	Self-report plus spirometric testing (GOLD stage I and higher)	2343	Mean: 58	10.9
					40–49	3.5
					50–59	5.8
					60–69	15.7
					70–79	24.4
Kojima et al^Citation91	Prospective cohort study of subjects undergoing health checkups. Study included questionnaire and spirometry (April 2001 to March 2002).	11,460 subjects without asthma or tuberculosis; 33.9% female; aged 25–74 years.	Spirometry (GOLD stage I and higher)	11,460	25–74	1.9
Tatsumi^Citation92	Cross-sectional survey of patients, conducted by Ministry of Health and Welfare.	220,000 with COPD (70% chronic bronchitis, 30% emphysema) in total population; 41% female; age NR.	Patients visiting hospitals or private clinics for treatment of COPD, chronic bronchitis, or emphysema (classification system not described)	NR	NR	0.20
The Netherlands
Bischoff et al^Citation62	Trend analysis of COPD data from a 27-year prospective cohort (based on patients in four general practices).	Approximately 15,000 patients aged ≥ 40 years from four general practices.	Diagnosis codes for “chronic bronchitis,” “lung emphysema,” and “COPD” from the general-practice database	∼ 15,000	≥40	5.44
Spain
Miravitlles et al^Citation93	Telephone survey throughout Spain to determine prevalence of COPD in representative sample of general population.	6758 total patients, 24% of whom reported one or more respiratory symptoms; 70.2% female; aged ≥ 40 years. Mean age: 58 years. Smokers in the survey sample:   current, 19.2%;   former, 18%;   never, 62.8%.	Patient reported being diagnosed with COPD by a physician	6758	≥40	0.43
			Patient reported being diagnosed with acute bronchitis by a physician	6758	≥40	14
Miravitlles et al^Citation94	Representative sample of 3802 residents of the general population aged 40–80 years in ten cities in Spain, using a questionnaire and offering pre- and postbronchodilator spirometry.	n = 3802; 52.7% female. Mean age: 56.6 years. Smokers: current, 26%; former, 30.9%.	Spirometry: GOLD (FEV1/FVC ratio < 0.70)	3802	40–80	10.2
					40–49	3.8
					50–59	7.0
					60–69	14.5
					70–80	22.8
Peña et al^Citation95	Cohort study based in the general population. A randomized, age- and sex-stratified sample of 5014 individuals was taken in 7 areas of Spain using census data. Mail and telephone contact were used to recruit subjects.	n = 3981; aged 40–69 years. 363 people had COPD, of which 269 had negative BDT, and 79 had positive BDT, with <88% (males) or <89% (females) predicted FEV1/FVC; 15 did not have BDT but had FEV1/FVC < 81% and FEV1< 70%.	Spirometry: ERS criteria were used (FEV1/FVC ratio <88% of predicted for men and <89% for women)	3981	40–69	9.1
					Nonsmokers (40–49 years)	M: 1.9; F: 3.4
					Nonsmokers (50–59 years)	M: 5.3; F: 2.8
					Nonsmokers (60–69 years)	M: 9.3; F: 5.2
					Ever-smokers (40–49 years)	M: 8.6; F: 4.3
					Ever-smokers (50–59 years)	M: 14.5; F: 2.8
					Ever-smokers (60–69 years)	M: 30.6; F: 6.1
De Torres et al^Citation96	Cross-sectional study of a cohort of self-selected current or former smokers who attended wards or clinics at two medical centers in Spain and who agreed to be screened for lung cancer and airway obstruction.	n = 764; 34.3% female. Mean age: 53 years Mean pack-years of smoking: 33 (36 M; 30 F).	Spirometry: GOLD	764 (current or former smokers)	Mean: 53	26
					≤50	19
					>50	26
Sweden
Ekberg-Aronsson et al^Citation97	Prospective, longitudinal population-based screening programme in Malmö.	Cohort of 22,044; 33.6% female; aged 27–61 years. Mean age, baseline: M, 46.4 (SD, 5.7); F, 47.5 (SD, 7.8).	Spirometry + self-reported symptoms on questionnaire; GOLD stage I and higher	22,044	<29	M: 4.2; F: 4.0
					30–34	M: 0; F: 0
					35–39	M: 11.6; F: 7.9
					40–44	M: 13.4; F: 5.4
					45–49	M: 19.8; F: 9.2
					50–54	M: 19.4; F: 10.2
					55–59	M: 28.0; F: 14.4
					60–64	M: 27.8; F: NR
Hasselgren et al^Citation98	Varmland County population-based cohort, first a postal survey then a clinical screening examination (only on those with symptoms).	4814 was the sample of the country population. Of survey responders, 206 were randomly picked for clinical examination; 43.8% female; aged 18–70 years. Mean age: 43 years. Smokers: M, 24.9%; F, 28.5%.	Spirometry: BTS criteria	4814	18–70	2.1
Lindberg et al^Citation4	Survey (mailed questionnaire) of a random sample of 4851 adults aged 20–69 years.	4851 were surveyed; of these, 645 were interviewed and had spirometry   Among the 666 invited for examination: 50.6% female; mean age 49.1 years. Smokers:    non, 45.3%; former, 28.2%; current, 26.5%.	Spirometry: GOLD	645	20–69	14.1
					20–44	9.1
					45–69	17.1
			Spirometry: BTS	645	20–69	7.6
					20–44	4.1
					45–69	9.7
			Spirometry: ERS	645	20–69	14
					20–44	11.6
					45–69	15.4
			Spirometry: ATS	645	20–69	34.1
					20–44	21.5
					45–69	41.7
			Clinical: ATS	645	20–69	12.2
					20–44	5.1
					45–69	16.5
Lindberg et al^Citation8	A random sample from a population-based survey in 1996 was invited to a screening interview and spirometry. People were from OLIN 1st survey in 1985.	n = 1237; 51% female; aged 46–77 years. Smokers:   (M) current, 24%; former, 47%; non, 29%.   (F) current, 26%; former, 24%; non, 51%.	Spirometry: GOLD	1237	46–77	14.3
					46–47	6.5
					61–62	17.1
					76–77	28.7
			Spirometry: BTS	1237	46–77	8.1
					46–47	2.8
					61–62	9.0
					76–77	19.7
Lindberg et al^Citation26	Ongoing population-based cohort with survey and subgroup invited for examination (3rd update of OLIN cohort 1).	5189 surveyed in 1996; 963 followed up who had spirometry data in 1996 and 2003; 51.4% female.   Ever smoked: 59%.   Mean FEV1% predicted: 97.45	Spirometry: GOLD stage I–IV	963	46–77	11.0
					46–47	7.4
					61–62	14.6
					76–77	18.7
Lindstrom et al^Citation99	Prospective cross-sectional studies of respiratory symptoms and diseases in two population samples of the same age living in Northern Sweden were performed six years apart (1986–1987 compared with 1993–1994) with postal questionnaire, structured interview, lung-function tests	Total study   1986: 5698   1992: 5617 Ages: 35–36; 50–51; 65–66. % female for questionnaire respondents:   49.2% (1986–1987), 51.0% (1993–1994); Clinical examination:   47.6% (1986–1987), 50.6% (1993–1994)	Spirometry: BTS	5617	35–66	11
					35–36	1.9
					50–51	7.2
					65–66	22.5
Lundbäck et al^Citation9	OLIN longitudinal population-based study, 3rd survey of the 1st cohort, sample taken of survey respondents.	1237 who had lung-function test that was technically adequate   Current smokers: M, 23.6%; F, 25.6%   Former smokers: M, 47.0%; F, 23.7%   Nonsmokers: M, 29.3%; F, 50.6%   Age range: 46–77 years.	Spirometry: BTS	1,237	46–77	8.1
					Nonsmokers: 46–47	1
					Nonsmokers: 61–62	2
					Nonsmokers: 76–77
					Smokers: 46–47	16
					Smokers: 61–62
					Smokers: 76–77	5
					46–77	24
					Nonsmokers:	45
			Spirometry: GOLD		46–47	14.3
					Nonsmokers: 61–62	3
						5
					Nonsmokers: 76–77	21
					Smokers: 46–47
					Smokers: 61–62	11
					Smokers: 76–77	42
						50
Montnémery et al^Citation100	Population-based survey in Malmö, sampled from population records of Southern Sweden.	Total sampled = 12,079; questionnaire sent and 8469 (70.1%) responded; 52.2% female Smokers: overall, 33.8%; M, 33.1%; F, 34.4%.	Self-reported chronic bronchitis or emphysema	8469	NR	4.6
Montnémery et al^Citation64	Population-based survey, Malmö	In 2000, questionnaire sent to 5179 randomly selected people; aged 20–59 years. Total respondents: 3692; 52.1% female. Smokers: overall, 28.4%; M, 28.0%, F, 28.1%.	Self-report of chronic bronchitis, emphysema, or COPD	3692	20–59	3.6
					20–29	1.9
					30–39	2.7
					40–49	4.1
					50–59	5.7
			Physician diagnosis of CBE/COPD	3692	20–59	4.3
Nihlen et al^Citation70	4933 people from a 1992 questionnaire; appears to be a subset of patients in a Montnémery study published in 1998. Original 1992 sample was population-based in the Malmö area; all aged 20–59 years in 1992.	4280 still in the study area who had been studied in 1992 and 2000; 53.9% female. Smokers: Current, 32.8 (1992); 26.3 (2000). Former, 24.8 (1992); 30.7 (2000).	Self-reported physician’s diagnosis of COPD, chronic bronchitis, and/or emphysema	4280	20–59	4.3
Pallasaho et al^Citation101	A random sample was sent a postal questionnaire in 1996 in Stockholm, Helsinki, and Tallinn (data for Stockholm and Helsinki only).	n = 18,741; 56.5% female. Stockholm: M: 2484 F: 2851 Smokers (M/F)%: 32/33 Helsinki M: 2429 F: 3242 Smokers: (M/F)%: 38/31.	Postal questionnaire and GP diagnosis of chronic bronchitis or emphysema	5335	NR	3.0
Rönmark et al^Citation102	A cross-sectional study by postal survey in Western Sweden. Random sample of 30,000 from population registry in Sweden, aged 16–75 years.	Total respondents: 18,087 (62%). Focus of study was impact of nonresponse.	Questionnaire asked about physician-diagnosed CBE/COPD	18,087	16–75	M: 2.5; F: 3.6
Wiréhen et al^Citation103	Population-based administrative health care database in Ostergöt-land County, with hospital and primary care data.	Data for residents of the area; a total of 415,000 people.	At least one health care contact for COPD using ICD-10 code J44 between 1999 and 2003	415,000	All ages	1.2
					0–14	M: 0; F: 0
					15–24	M: 0; F: 0
					25–34	M: 0; F: 0
					35–44	M: 0; F: 0.2
					45–54	M: 0.5; F: 0.8
					55–64	M: 1.7; F: 1.9
					65–74	M: 4.0; F: 4.1
					75–84	M: 6.7; F: 4.2
					≥85	M: 6.5; F: 2.7
UK
Faulconer and de Lusignan^Citation104	Audit of UK general-practice electronic records for quality of coding of COPD.	Patients in practice = 10,975. Age and sex in the practice were distributed similarly to general population; % female: NR. Smoking in those with correct diagnosis of COPD: current, 41.1%; former, 42.7%; never, 11.3%.	Read codes for COPD: H36, H37, H38, and H3z	10,975	NR	1.3
Murtagh et al^Citation105	Two-stage survey of Greater Belfast population aged 40–69 years; a subsample had spirometry.	Postal survey to 4000; 67% response to survey. 1330 eligible for next part of study. 722 had full assessment Among 722 subjects: F, 54.6% of symptomatic and 44.7% of asymptomatic. Mean age of symptomatic: 45.4 years; asymptomatic: 55.3 years.	MRC Respiratory Symptoms Questionnaire, MRC Dyspnoea Scale, GP diagnosis; spirometry: GOLD	722	40–69	6.3
					40–49	M: 4.9; F:1.4
					50–59	M: 9.5; F: 4.7
					60–69	M: 12.3; F: 4.5
Nacul et al^Citation106	Mathematical model using demographic data to estimate undiagnosed plus diagnosed burden of COPD; uses data from Health Survey for England 2001. HSE had lung-function data.	Population-based national survey data from 10,750 respondents, aged ≥15 years, used as input to model that also uses risk-factor relationships from literature to estimate prevalence of COPD in England. Final model included sex, age, smoking, ethnicity, rural/urban residence, deprivation index. Baseline odds of COPD taken from the survey data for nonsmokers <35 years.	Spirometry: BTS criteria	10,750	≥15	3.1
					15–44	1.10
					45–54	2.19
					55–64	5.48
					65–74	7.29
					≥75	7.89
Shahab et al^Citation65	A study using HSE data to describe the prevalence and extent of underdetection of spirometry-defined COPD in England. Private households were identified with a multistage probability samplingdesign and its members invited to participate. Data were collected on age, sex, ethnicity, and occupational status.	Total sample 8215; 53.6% female; aged >35 years in HSE, self-report data, and valid spirometry. Mean age: 55.5 years. Smokers: current, 24.1%; ever, 55.1%.	Spirometry: ATS/ERS criteria	8215	>35	13.3
			Self-reported diagnosis of chronic bronchitis or emphysema	8215	>35	1.1
Soriano et al^Citation71	Retrospective cohort study in UK database of general-practice electronic medical record data (GPRD). 3.4 million patients in data in 1998.	Total 78,172 patients with diagnosed prevalent COPD in 1990; 45.9% female. Mean age: 66.7 years. Incident COPD cases in 1990–1997: 50,174 in total. 146,026 person-years of follow-up.	Diagnosed COPD found with OXMIS codes in GP records	78,172	Mean: 66.7	M: 1.35; F: 0.80
USA
Bang et al^Citation107	Retrospective study of data from the NHIS (1997–2004).	127,624,000 adult workers; 46.3% female; aged ≥18 years.	Self-reported chronic bronchitis or emphysema	127,624,000	>18	4.0
					18–44	3.5
					45–64	4.8
					65–74	6.9
					≥75	6.8
Bhattacharyya^Citation108	Retrospective study of data from the NHIS (1997–2006).	313,982 adults. Mean age: 45.2 years.	Self-reported chronic bronchitis	313,982	Mean 45.2	4.8
Bhattacharyya^Citation109	Retrospective study of data from the NHIS (1998–2006).	851,581 adults; 21.8% female (M:F ratio, 0.93:1). Mean age: 35.7 years.	Self-reported chronic bronchitis	851,581	Mean 35.7	4.5
Celli et al^Citation5	NHANES III (1988–1994) population-based survey. Included questionnaire, laboratory examination, and lung-function testing.	9838 subjects, aged 30–80 years, of Caucasian, non-Hispanic white, non-Hispanic black, or Mexican American origin with a satisfactory spirometry test.	Self-reported chronic bronchitis or emphysema	9838	30–80	7.73
					30–34	4.93
					35–39	3.95
					40–44	6.56
					45–49	7.71
					50–54	8.68
					55–59	9.23
					60–64	10.94
					65–69	12.40
					70–74	13.70
					75–80	12.19
			GOLD stage IIa or higher	9838	30–80	7.87
					30–34	1.73
					35–39	1.82
					40–44	3.57
					45–49	5.02
					50–54	10.25
					55–59	13.76
					60–64	15.24
					65–69	17.93
					70–74	18.90
					75–80	19.48
			Spirometry: ATS	9838	30–80	14.2
					30–34	8.37
					35–39	9.25
					40–44	11.58
					45–49	13.88
					50–54	15.61
					55–59	19.18
					60–64	19.77
					65–69	21.25
					70–74	22.86
					75–80	22.72
			Spirometry: ERS	9838	30–80	16.0
					30–34	9.04
					35–39	10.01
					40–44	12.71
					45–49	15.25
					50–54	17.88
					55–59	21.21
					60–64	23.44
					65–69	25.61
					70–74	25.83
					75–80	26.18
			GOLD stage I or higher	9838	30–80	16.8
					30–34	4.47
					35–39	5.46
					40–44	9.48
					45–49	13.35
					50–54	18.19
					55–59	25.56
					60–64	31.15
					65–69	34.54
					70–74	40.62
					75–80	41.69
Chamberlain et al^Citation110 ARIC study	Prospective population-based cohort study of four cities to determine burden of COPD on all-cause mortality (baseline: 1987–1989; end: 2004). Included home interview and four clinic visits. Follow-up: 15 years.	10,333 adults; aged 45–64 years. 2047 black (59.5% female); 8286 white (52.6% female).	GOLD stage II or higher	10,333	45–64	Black M: 13.1; F: 4.9 White M: 15.2; F: 7.4
Hnizdo et al^Citation14	Data from NHANES III in a working population (1988–1994). Included questionnaire, laboratory examination, and lung-function testing.	9823 subjects aged 30–75 years. These excluded subjects with problems with lung-function tests, diagnosed current asthma, or missing occupational code.	GOLD stage II or higher	9823	30–75	7.1
					30–39	1.9
					40–49	6.7
					50–59	13.3
					60–75	17.5
			Physician-diagnosed emphysema	9823	30–75	1.6
			Physician-diagnosed chronic bronchitis	9823	30–75	4.5
Hnizdo et al^Citation111	Data from the NHANES III in a working population (1988–1994). Included questionnaire, laboratory examination, and lung-function testing.	9428 subjects aged 30–75 years. These excluded subjects with problems with lung-function tests, diagnosed current asthma, missing occupational code, or unspecified racial/ethnic background.	Airflow obstruction (FEV1/FVC < 75% and FEV1 < 80% predicted)	9428	30–75	Caucasian: 10.7 African-American: 7.5 Mexican-American: 3.9
Hnizdo et al^Citation6	Retrospective analysis of data from population-based NHANES III (1988–1994). Included questionnaire and spirometry.	13,842 subjects, aged 20–80 years, of Caucasian, African-American, or Mexican-American origin, with spirometry data.	GOLD stage I	13,842	20–80	14.2
					20–49	6.3
					50–80	30.5
			GOLD stage II or higher	13,842	20–80	6.9
					20–49	2.5
					50–80	16.1
			LLN-1 (mild or greater severity): FEV1/FVC < LLN; FEV1 < 00% predicted	13,842	20–80	12.3
					20–49	8.9
					50–80	19.2
			LLN-2 (moderate or greater severity): FEV1/FVC < LLN; FEV1 < LLN (∼80% predicted)	13,842	20–80	6.2
					20–49	3.6
					50–80	11.8
			Self-reported chronic bronchitis	13,842	20–80	5.7
					20–49	5.0
					50–80	7.2
			Self-reported emphysema	13,842	20–80	1.8
					20–49	0.5
					50–80	4.6
Jackson and Hubbard^Citation112	Cross-sectional survey (NHANES III) (study period unknown).	3874 white subjects, aged 50–90 years, not including people with self-reported asthma.	Airflow obstruction (FEV1/FVC < 70% and FEV1 < 80% predicted)	3874	50–90	7.1
Jordan and Mann^Citation113	Retrospective cohort study of subjects in the NHANES III (1988–1994)	16,707 subjects aged > 17 years with spirometry data and completing the interview.	GOLD stage I or higher	16,707	>17	15.1
Lipton et al^Citation114	Retrospective database analysis of annual audited hospital discharge data in 1707 zip codes in California (2000).	3,775,711 patients discharged from hospital.	ICD-9 codes	3,775,711	NR	7.3
Mannino et al^Citation67	Retrospective analysis of data from NHANES III (1988–1994).	16,084 subjects aged ≥17 years, classified as white or black, with lung-function testing; 52.3% female. Mean age: 42.8 years. FEV1 predicted, 95.3%; FEV1/FVC ratio: 0.79.	GOLD stage II or higher	16,084	>17	6.8
Mannino et al^Citation15	NHIS (1997–2000).	Adults aged ≥ 25 years.	Self-reported chronic bronchitis or emphysema	NR	≥25	6.0
					25–44	3.85
					45–54	5.92
					55–64	7.95
					65–74	9.64
					≥75	10.60
Mannino et al^Citation15	NHANES I (1971–1975).	5080 noninstitutionalized adults with spirometry data.	GOLD stage I	5080	≥25	7.39
					25–44	4.89
					45–54	10.11
					55–64	12.32
					65–74	13.35
					≥75	NR
			GOLD stage II or higher	5080	≥25	7.74
					25–44	4.43
					45–54	9.73
					55–64	14.07
					65–74	17.38
					≥75	NR
Mannino et al^Citation15	NHANES III (1988–1994).	13,869 noninstitutionalized adults with spirometry data.	GOLD stage I	13,869	≥25	6.9
					25–44	3.68
					45–54	8.71
					55–64	12.62
					65–74	16.54
					≥75	17.82
			GOLD stage II or higher	13,869	≥25	6.57
					25–44	2.29
					45–54	7.24
					55–64	14.05
					65–74	20.66
					≥75	22.93
Mannino et al^Citation15	NHANES III, phase 2 (1991–1994).	6600 noninstitutionalized adults aged ≥ 25 years with spirometry data.	Physician-diagnosed COPD	6600	≥25	4.7
			GOLD stage I	6600	≥25	7.4
			GOLD stage II or higher	6600	≥25	8.0
Mannino et al^Citation115	Retrospective study of data from NHANES I (1971–1975), including original survey, hospital records, and death certificates. Follow-up surveys conducted 1982–1984, 1986, 1987, and 1992. Follow-up: 22 years.	5542 noninstitutionalized adults with satisfactory lung-function test data; 54.7% female; aged 25–74 years.	Symptoms only GOLD stage I	5542	25–74	16.1
				5542	25–74	7.9
					25–39	4.0
					40–49	7.0
					50–59	9.5
					60–69	12.7
					70–74	14.1
			GOLD stage II	5542	25–74	7.1
					25–39	2.8
					40–49	5.9
					50–59	10.4
					60–69	10.7
					70–74	13.5
Methvin et al^Citation16	Survey including questionnaire and spirometry (BOLD study) (study period not reported).	508 noninstitutionalized adults aged ≥ 40 years with completed questionnaires, and pre- and postbronchodilator spirometry; 59.5% female.	Self-reported COPD or chronic bronchitis	508	≥40	17.1
			Self-reported emphysema	508	≥40	8.6
			GOLD stage I or higher	508	≥40	19.6
					40–49	6.1
					50–59	19.1
					60–69	27.4
					≥70	35.2
O’Malley et al^Citation116	Medicare claims database analysis (2000–2002).	509,613 Medicare beneficiaries, aged ≥ 65 years, who did not die; enter hospice, long-term care facility, or Medicare-managed care; and who did not have end-stage renal disease in 2000; 62% female.	ICD-9 codes	509,613	≥65	17.9
Pleis and Barnes^Citation117	Retrospective study of data from the NHIS (2000–2003).	127,596 civilian noninstitutionalized adults from NHIS; 51.0%–51.8% female.	Self-reported COPD or CBE	127,596	NR	White: 6 American Indian or Alaska native: 6.5 White and American Indian or Alaska native: 13.1
Schneider et al^Citation118	Administrative claims database analysis of the Medicare Chronic Condition Data Warehouse (2005).	1,649,574 Medicare beneficiaries; 56.6% female. Aged: <65 years, 15.4%; 65–74 years, 38.9%; 75–84 years, 32.2%; ≥85 years, 13.5%.	ICD-9 and HCPCS codes	1,649,574	All patients	10.9
Tinkelman et al^Citation119	Retrospective analysis of managed care administrative claims database (2000–2001).	414,231 enrollees; 56.8% female; aged ≥ 45 years. Mean age: 66.2 years.	ICD-9 codes	414,231	≥45	4.7
					45–54	0.96
					55–64	3.14
					65–74	5.90
					75–84	7.58
					≥85	7.27
Vaz Fragoso et al^Citation7	Retrospective cohort study of subjects in the NHANES III (1988–1994). Followed up until December 2000.	3502 white subjects aged 40–80 years with no self-reported asthma and with acceptable spirometry data; 52.2% female. Mean age: 60.7 years. Subjects each had a mean of 0.69 self-reported physician-diagnosed chronic conditions.	ATS/ERS defined LLN at the 5th percentile (ATS/ERS-LLN5)	3502	40–80	7.1
					40–64	15.6
					65–80	19.2
			GOLD stage I or higher	3502	40–80	27.0
					40–64	19.1
					65–80	37.7
			(LMS-LLN5)	3502	40–80	13.8
					40–64	14.3
					65–80	13.2
Wilson et al^Citation120	Retrospective study of data from the NHIS (1985–1996).	NR.	ICD-9 codes for chronic bronchitis and emphysema	NR	NR	Overall: 6.18 Chronic bronchitis: 5.4% Emphysema: 0.78%
Celli et al^Citation13	NHANES III (1988–1994) population-based survey. Included questionnaire, laboratory examination, and lung-function testing.	10,276 subjects aged 30–80 years with a satisfactory spirometry test. Never-smokers: 4544; ever-smokers: 5732.	GOLD stage I or higher	10,276 (4544 never-smokers; 5732 ever-smokers)	30–80	16.50
					Never-smokers only: 30–39	3.04
					Never-smokers only: 40–49	8.33
					Never-smokers only: 50–59	7.15
					Never-smokers only: 60–69	16.02
					Never-smokers only: 70–80	28.03
			Self-reported chronic bronchitis or emphysema (ever)	5732	Ever-smokers only: 30–80	10.0
				4544	Never-smokers only: 30–80	4.5
Ohar et al^Citation121	Cohort study of subjects referred for a work-related medical evaluation (1980–2008), including questionnaire, chest radiographs, and lung-function tests.	3955 subjects screened for a work-related medical evaluation. Mean age: 64.1 years. 1038 nonsmokers or <20 pack-years smokers; 74.9% FEV1 predicted.	Spirometry: GOLD stage I or higher Self-reported COPD, chronic bronchitis, emphysema, or asthma	3955	Mean: 64.1	Overall: 37.0 Smokers: 43.5 Smokers: 18.0

Abbreviations: ATS, American Thoracic Society; ATS/ERS-LLN₅, ATS/ERS-defined LLN at the 5th percentile; BDT, bronchodilator test; BTS, British Thoracic Society; CBE, chronic bronchitis or emphysema; CCHS, Canadian Community Health Survey; COPD, chronic obstructive pulmonary disease; ECRHS, European Community Respiratory Health Survey; ERS, European Respiratory Society; F, female; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; GP, general practitioner; GPRD, General Practice Research Database; HCPCS, Healthcare Common Procedure Coding System; HIS6, a population-based survey; HSD, a computerized general-practice database; HSE, Health Survey for England; ICD-9, International Classification of Diseases, 9th Revision; ICD-10, International Classification of Diseases, 10th Revision; LLN, lower limit of normal; LMS-LLN₅, lambda-mu-sigma-defined LLN at the 5th percentile; M, male; MOH, Ministry of Health; NA, not applicable; NHANES, National Health and Nutrition Examination Survey; NHIS, National Health Interview Survey; NR, not reported; OLIN, obstructive lung disease in Northern Sweden; SD, standard deviation; UK, United Kingdom; USA, United States of America.

Al-HazmiMWooldrageKAnthonisenNRAirflow obstruction in young adults in CanadaCan Respir J200714422121717551598

 PubMed Web of Science ®Google Scholar

CricelliCMazzagliaGSamaniFPrevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databasesJ Public Health Med200325325425714575204

 PubMedGoogle Scholar

ViegiGMatteelliGAnginoAThe proportional Venn diagram of obstructive lung disease in the Italian general populationChest200412641093110115486369

 PubMed Web of Science ®Google Scholar

LindbergAJonssonACRönmarkELundgrenRLarssonLGLundbäckBPrevalence of chronic obstructive pulmonary disease according to BTS, ERS, GOLD, and ATS criteria in relation to doctor’s diagnosis, symptoms, age, gender, and smoking habitsRespiration200572547147916210885

 PubMed Web of Science ®Google Scholar

LundbäckBLindbergALindstromMObstructive Lung Disease in Northern Sweden StudiesNot 15 but 50% of smokers develop COPD? – Report from the Obstructive Lung Disease in Northern Sweden StudiesRespir Med200397211512212587960

 PubMed Web of Science ®Google Scholar

LindbergABjergARönmarkELarssonLGLundbäckBPrevalence and underdiagnosis of COPD by disease severity and the attributable fraction of smoking. Report from the obstructive lung disease in Northern Sweden studiesRespir Med2006100226427215975774

 PubMed Web of Science ®Google Scholar

MontnémeryRNihlenUAnderssonMObstructive airways diseases, smoking, and use of inhaled corticosteroids in southern Sweden in 1992 and 2000Int J Tuberc Lung Dis200610549049816704029

 PubMed Web of Science ®Google Scholar

ShahabLJarvisMJBrittonJWestRPrevalence, diagnosis, and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sampleThorax200661121043104717040932

 PubMed Web of Science ®Google Scholar

SorianoJBDavisKJColemanBVisickGManninoDPrideNBThe proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United KingdomChest2003124247448112907531

 PubMed Web of Science ®Google Scholar

CelliBRHalbertRJIsonakaSSchauBPopulation impact of different definitions of airway obstructionEur Respir J200322226827312952259

 PubMed Web of Science ®Google Scholar

CelliBRHalbertRJNordykeRJSchauBAirway obstruction in never smokers: results from the third national health and nutrition examination surveyAm J Med2005118121364137216378780

 PubMed Web of Science ®Google Scholar

HnizdoESullivanPABangKMWagnerGAssociation between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the third national health and nutrition examination surveyAm J Epidemiol2002156873874612370162

 PubMed Web of Science ®Google Scholar

HnizdoEGlindmeyerHWPetsonkELEnrightPBuistASCase definitions for chronic obstructive pulmonary diseaseCOPD2006329510017175672

 PubMedGoogle Scholar

ManninoDMGagnonRCPettyTLLydickEObstructive lung disease and low lung function in adults in the United States: data from the national health and nutrition examination survey, 1988–1994Arch Intern Med2000160111683168910847262

 PubMed Web of Science ®Google Scholar

ManninoDMHomaDMAkinbamiLJFordESReddSCChronic obstructive pulmonary disease surveillance: United States, 1971–2000MMWR Surveill Summ2002516116

 Google Scholar

MethvinJNManninoDMCaseyBRCOPD prevalence in southeastern Kentucky: the burden of lung disease studyChest2009135110210718689574

 PubMed Web of Science ®Google Scholar

Vaz FragosoCAConcatoJMcAvayGThe ratio of FEV1 to FVC as a basis for establishing chronic obstructive pulmonary diseaseAm J Respir Crit Care Med2010181544645120019341

 PubMed Web of Science ®Google Scholar

CerveriIAccordiniSVerlatoGEuropean Community Respiratory Health Survey (ECRHS) Study GroupVariations in the prevalence across countries of chronic bronchitis and smoking habits in young adultsEur Respir J2001181859211510810

 PubMed Web of Science ®Google Scholar

American Thoracic SocietyEvaluation of impairment/disability secondary to respiratory disordersAm Rev Respir Dis1986133120512093509148

 PubMed Web of Science ®Google Scholar

SiafakasNMVermeirePPrideNBOptimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task ForceEur Respir J8199588139814207489808

 PubMed Web of Science ®Google Scholar

de MarcoRAccordiniSCerveriIIncidence of chronic obstructive pulmonary disease in a cohort of young adults according to the presence of chronic cough and phlegmAm J Respir Crit Care Med20071751323917008642

 PubMed Web of Science ®Google Scholar

GershonASWangCWiltonASRautRToTTrends in chronic obstructive pulmonary disease prevalence, incidence, and mortality in Ontario, Canada, 1996 to 2007: a population-based studyArch Intern Med2010170656056520308643

 PubMed Web of Science ®Google Scholar

KojimaSSakakibaraHMotaniSIncidence of chronic obstructive pulmonary disease, and the relationship between age and smoking in a Japanese populationJ Epidemiol2007172546017420613

 PubMed Web of Science ®Google Scholar

LindbergAJonssonACRönmarkELundgrenRLarssonLGLundbäckBTen-year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohortChest200512751544155215888826

 PubMed Web of Science ®Google Scholar

NihlenUNybergPMontnémeryPLofdahlCGInfluence of family history and smoking habits on the incidence of self-reported physician’s diagnosis of COPDRespir Med200498326327015002763

 PubMed Web of Science ®Google Scholar

LindbergAErikssonBLarssonLGRönmarkESandstromTLundbäckBSeven-year cumulative incidence of COPD in an age-stratified general population sampleChest2006129487988516608933

 PubMed Web of Science ®Google Scholar

García RodríguezLAWallanderMATolosaLBJohanssonSChronic obstructive pulmonary disease in UK primary care: incidence and risk factorsCOPD20096536937919863366

 PubMedGoogle Scholar

SorianoJBMaierWCEggerPRecent trends in physician diagnosed COPD in women and men in the UKThorax200055978979410950900

 PubMed Web of Science ®Google Scholar

BerendNEpidemiological survey of chronic obstructive pulmonary disease and alpha-1-antitrypsin deficiency in AustraliaRespirology2001Suppl 6S21S2511438021

 PubMedGoogle Scholar

TanWCSealePIpMTrends in COPD mortality and hospitalizations in countries and regions of Asia-PacificRespirology2009141909719144054

 PubMed Web of Science ®Google Scholar

StewartPMcRaeLKeeping track of COPD in CanadaCan Respir J200714Suppl A5A7A

 Google Scholar

FuhrmanCJouglaENicolauJEilsteinDDelmasMCDeaths from chronic obstructive pulmonary disease in France, 1979–2002: a multiple cause analysisThorax2006611193093416738039

 PubMed Web of Science ®Google Scholar

DayGEProvostELanierAPAlaska native mortality rates and trendsPublic Health Rep20091241546419413028

 PubMed Web of Science ®Google Scholar

DayGELanierAPAlaska native mortality, 1979–1998Public Health Rep2003118651853014563909

 PubMed Web of Science ®Google Scholar

EdwardsNMUmlandMAhrensDRemingtonPThe silent epidemic among Wisconsin women: chronic obstructive pulmonary disease trends, 1980–2000WMJ20051044505416117235

 PubMedGoogle Scholar

JemalAWardEHaoYThunMTrends in the leading causes of death in the United States, 1970–2002JAMA2005294101255125916160134

 PubMed Web of Science ®Google Scholar

KazerouniNAlversonCJReddSCMottJAManninoDMSex differences in COPD and lung cancer mortality trends: United States, 1968–1999J Womens Health. (Larchmt)2004131172315006274

 PubMed Web of Science ®Google Scholar

MillerNSimoesEJChangJCRoblingAGTrends in chronic obstructive pulmonary disease mortalityMo Med2000973879010745650

 PubMedGoogle Scholar

Centers for Disease Control and Prevention (CDC)Deaths from chronic obstructive pulmonary disease: United States, 2000–2005MMWR Morb Mortal Wkly Rep200857451229123219008792

 PubMedGoogle Scholar

SinghGKHiattRATrends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979–2003Int J Epidemiol200635490391916709619

 PubMed Web of Science ®Google Scholar

PolednakAPTrends in mortality from COPD in selected US states differing in tobacco control effortsCOPD201071636920214465

 PubMedGoogle Scholar

Boutin-ForzanoSMoreauDKalabokaSReported prevalence and co-morbidity of asthma, chronic bronchitis and emphysema: A pan-European estimationInt J Tuberc Lung Dis200711669570217519104

 PubMed Web of Science ®Google Scholar

BuistASMcBurnieMAVollmerWMInternational variation in the prevalence of COPD (the BOLD Study): a population-based prevalence studyLancet2007370958974175017765523

 PubMed Web of Science ®Google Scholar

MenottiAMulderINissinenAGiampaoliSFeskensEJKromhoutDPrevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly)J Clin Epidemiol200154768068611438408

 PubMed Web of Science ®Google Scholar

RennardSDecramerMCalverleyPMImpact of COPD in North America and Europe in 2000: subjects’ perspective of Confronting COPD International SurveyEur Respir J200220479980512412667

 PubMed Web of Science ®Google Scholar

SvanesCOmenaasEJarvisDChinnSGulsvikABurneyPParental smoking in childhood and adult obstructive lung disease: Results from the European Community Respiratory Health SurveyThorax200459429530215047948

 PubMed Web of Science ®Google Scholar

de MarcoRAccordiniSCerveriIEuropean Community Respiratory Health Survey Study GroupAn international survey of chronic obstructive pulmonary disease in young adults according to GOLD stagesThorax200459212012514760151

 PubMed Web of Science ®Google Scholar

CampPGChaudhryMPlattHThe sex factor: epidemiology and management of chronic obstructive pulmonary disease in British ColumbiaCan Respir J200815841742219107241

 PubMed Web of Science ®Google Scholar

LacasseYMontoriVMLanthierCMaltisFThe validity of diagnosing chronic obstructive pulmonary disease from a large administrative databaseCan Respir J200512525125616107913

 PubMedGoogle Scholar

OhinmaaASchopflocherDJacobsPA population-based analysis of health behaviours, chronic diseases and associated costsChronic Dis Can2006271172416672136

 PubMedGoogle Scholar

StewartPMcRaeLKeeping track of COPD in CanadaCan Respir J200714Suppl A5A7A

 Google Scholar

ChenYBreithauptKMuhajarineNOccurrence of chronic obstructive pulmonary disease among Canadians and sex-related risk factorsJ Clin Epidemiol200053775576110941954

 PubMed Web of Science ®Google Scholar

HillKGoldsteinRSGuyattGHPrevalence and underdiagnosis of chronic obstructive pulmonary disease among patients at risk in primary careCMAJ2010182767367820371646

 PubMed Web of Science ®Google Scholar

VozorisNLougheedMDSecond-hand smoke exposure in Canada: prevalence, risk factors, and association with respiratory and cardiovascular diseasesCan Respir J200815526326918716689

 PubMed Web of Science ®Google Scholar

HuchonGJVergnenegreANeukirchFBramiGRocheNPreuxPMChronic bronchitis among French adults: high prevalence and underdiagnosisEur Respir J200220480681212412668

 PubMed Web of Science ®Google Scholar

AnecchinoCRossiEFanizzaCDe RossiMTognoniGRomeroMworking group ARNO projectPrevalence of chronic obstructive pulmonary disease and pattern of comorbidities in a general populationInt J Chron Obstruct Pulmon Dis20072456757418268930

 PubMedGoogle Scholar

FukahoriSMatsuseHTakamuraNPrevalence of chronic obstructive pulmonary diseases in general clinics in terms of FEV1/FVCInt J Clin Pract200963226927419196365

 PubMed Web of Science ®Google Scholar

FukuchiYNishimuraMIchinoseMCOPD in Japan: the Nippon COPD Epidemiology studyRespirology20049445846515612956

 PubMed Web of Science ®Google Scholar

KojimaSSakakibaraHMotaniSEffects of smoking and age on chronic obstructive pulmonary disease in JapanJ Epidemiol200515411311716141629

 PubMed Web of Science ®Google Scholar

TatsumiKEpidemiological survey of chronic obstructive pulmonary disease in JapanRespirology20016 SupplS27S3311438022

 PubMedGoogle Scholar

BischoffEWSchermerTRBorHBrownPvan WeelCvan den BoschWJTrends in COPD prevalence and exacerbation rates in Dutch primary careBr J Gen Pract20095956992793319891824

 PubMed Web of Science ®Google Scholar

MiravitllesMde la RozaCMoreraJChronic respiratory symptoms, spirometry and knowledge of COPD among general populationRespir Med2006100111973198016626950

 PubMed Web of Science ®Google Scholar

MiravitllesMSorianoJBGarcía-RíoFPrevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activitiesThorax2009641086386819553233

 PubMed Web of Science ®Google Scholar

PeñaVSMiravitllesMGabrielRGeographic variations in prevalence and underdiagnosis of COPD: results of the IBER-POC multicentre epidemiological studyChest2000118498198911035667

 PubMed Web of Science ®Google Scholar

de TorresJPCampoACasanovaCAguirre-JaimeAZuluetaJGender and chronic obstructive pulmonary disease in high-risk smokersRespiration200673330631016330871

 PubMed Web of Science ®Google Scholar

Ekberg-AronssonMLofdahlKNilssonJALofdahlCGNilssonPMHospital admission rates among men and women with symptoms of chronic bronchitis and airflow limitation corresponding to the GOLD stages of chronic obstructive pulmonary disease--a population-based studyRespir Med2008102110912017928213

 PubMed Web of Science ®Google Scholar

HasselgrenMArneMLindahlAJansonSLundbäckBEstimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health careScand J Prim Health Care2001191545711303549

 PubMed Web of Science ®Google Scholar

LindstromMJonssonELarssonKLundbäckBUnderdiagnosis of chronic obstructive pulmonary disease in Northern SwedenInt J Tuberc Lung Dis200261768411931405

 PubMed Web of Science ®Google Scholar

MontnémeryPBengtssonPElliotALindholmLHNybergPLofdahlCGPrevalence of obstructive lung diseases and respiratory symptoms in relation to living environment and socio-economic groupRespir Med200195974475211575896

 PubMed Web of Science ®Google Scholar

PallasahoPLundbäckBMerenMPrevalence and risk factors for asthma and chronic bronchitis in the capitals Helsinki, Stockholm, and TallinnRespir Med2002961075976912412974

 PubMed Web of Science ®Google Scholar

RönmarkEPEkerljungLLötvallJTorénKRönmarkELundbäckBLarge scale questionnaire survey on respiratory health in Sweden: Effects of late- and non-responseRespir Med2009103121807181519695859

 PubMed Web of Science ®Google Scholar

WiréhenABKarlssonHMCarstensenJMEstimating disease prevalence using a population-based administrative healthcare databaseScand J Public Health200735442443117786807

 PubMed Web of Science ®Google Scholar

FaulconerERde LusignanSAn eight-step method for assessing diagnostic data quality in practice: chronic obstructive pulmonary disease as an exemplarInform Prim Care200412424325415808026

 PubMedGoogle Scholar

MurtaghEHeaneyLGinglesJPrevalence of obstructive lung disease in a general population sample: the NICECOPD studyEur J Epidemiol200520544345316080593

 PubMed Web of Science ®Google Scholar

NaculLCSoljakMMeadeTModel for estimating the population prevalence of chronic obstructive pulmonary disease: Cross sectional data from the health survey for EnglandPopul Health Metr20075817897444

 PubMedGoogle Scholar

BangKMSyamlalGMazurekJMPrevalence of chronic obstructive pulmonary disease in the U.S. working population: an analysis of data from the 1997–2004 National Health Interview SurveyCOPD20096538038719863367

 PubMedGoogle Scholar

BhattacharyyaNContemporary assessment of the disease burden of sinusitisAm J Rhinol Allergy200923439239519671253

 PubMed Web of Science ®Google Scholar

BhattacharyyaNDoes annual temperature influence the prevalence of otolaryngologic respiratory diseases?Laryngoscope2009119101882188619598211

 PubMed Web of Science ®Google Scholar

ChamberlainAMSchabathMBFolsomARAssociations of chronic obstructive pulmonary disease with all-cause mortality in Blacks and Whites: the atherosclerosis risk in communities (ARIC) studyEthn Dis200919330831419769014

 PubMed Web of Science ®Google Scholar

HnizdoESullivanPABangKMWagnerGAirflow obstruction attributable to work in industry and occupation among U.S. race/ethnic groups: a study of NHANES III dataAm J Ind Med200446212613515273964

 PubMed Web of Science ®Google Scholar

JacksonHHubbardRDetecting chronic obstructive pulmonary disease using peak flow rate: Cross sectional surveyBr Med J2003327741665365414500437

 PubMed Web of Science ®Google Scholar

JordanJGJrMannJRObesity and mortality in persons with obstructive lung disease using data from the NHANES IIISouth Med J2010103432333020224489

 PubMed Web of Science ®Google Scholar

LiptonRBanerjeeADowlingKCTrenoAJThe geography of COPD hospitalization in CaliforniaCOPD20052443544417147009

 PubMedGoogle Scholar

ManninoDMBuistASPettyTLEnrightPLReddSCLung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up studyThorax200358538839312728157

 PubMed Web of Science ®Google Scholar

O’MalleyASPhamHHSchragDWuBBachPBPotentially avoidable hospitalizations for COPD and pneumonia: the role of physician and practice characteristicsMed Care200745656257017515784

 PubMed Web of Science ®Google Scholar

PleisJRBarnesPMA comparison of respiratory conditions between multiple race adults and their single race counterparts: An analysis based on American Indian/Alaska Native and white adultsEthn Health200813539941518850367

 PubMed Web of Science ®Google Scholar

SchneiderKMO’DonnellBEDeanDPrevalence of multiple chronic conditions in the United States’ Medicare populationHealth Qual Life Outcomes200978219737412

 PubMed Web of Science ®Google Scholar

TinkelmanDGGeorgeDHalbertRJChronic obstructive pulmonary disease in patients under age 65: Utilization and costs from a managed care sampleJ Occup Environ Med200547111125113016282873

 PubMed Web of Science ®Google Scholar

WilsonLDevineEBSoKDirect medical costs of chronic obstructive pulmonary disease: chronic bronchitis and emphysemaRespir Med200094320421310783930

 PubMed Web of Science ®Google Scholar

OharJASadeghnejadAMeyersDADonohueJFBleeckerERDo symptoms predict COPD in smokers?Chest201013761345135320363841

 PubMed Web of Science ®Google Scholar