Estimating prevalence of chronic obstructive pulmonary disease in the Southern Cone of Latin America: how different spirometric criteria may affect disease burden and health policies
Research Article
Fernando Lanas1 
Pamela Serón1 
Chung-Shiuan Chen2 
Jiang He2 
Jacqueline Ponzo3 
Allison Lee4 
Laura Gutierrez5 
Vilma E. Irazola5 
Edgardo Sobrino5 
Adolfo L. Rubinstein6 
Matías Calandrelli7 
Nora Mores8 
[1] CIGES, Faculty of Medicine of the Universidad de la Frontera, Temuco, Chile;Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA;Department of Family and Community Medicine, Universidad de la República, Montevideo, Uruguay;Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY, USA;Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina;National Ministry of Health, Buenos Aires, Argentina;Sanatorio San Carlos, Bariloche, Argentina;Secretaría de Salud, Municipalidad de Marcos Paz, Pcia. de Buenos Aires, Argentina;
BackgroundChronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. The study aimed to determine and compare the prevalence of COPD in the general population aged 45-74 years old according to fixed ratio and lower limit of normal (LLN) thresholds in four cities in the Southern Cone of Latin America.MethodsThe Pulmonary Risk in South America (PRISA) study used a 4-stage stratified sampling method to select 5814 participants from 4 cities in the Southern Cone of Latin America (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Data on demographic information, medical history, risk factors, pre-bronchodilator and post-bronchodilator spirometry were obtained using a standard protocol. According to GOLD, COPD was defined as a post-bronchodilator ratio of forced expiratory volume in one second (FEV1) over forced vital capacity (FVC) less than 70%. The LLN threshold was defined as the lower fifth percentile for predicted FEV1/FVC, and was evaluated as an alternative COPD definition.ResultsOverall COPD prevalence was 9.3% (95% CI 8.4, 10.2%), and men had a higher prevalence [11.8% (95% CI 10.3, 13.3%)] than women [7.3% (95% CI 6.2, 8.3%)] with the fixed ratio. Overall COPD prevalence using LLN was 4.7% (95% CI 4.1, 5.3%), higher in men: 5.8% (95% CI 4.7, 6.8%) than women: 3.9% (95% CI 3.1, 4.7%). COPD prevalence was significantly higher among those who were older, had