Introduction
Methods
Setting
Design
Data collection
Definitions
Biostatistical methods
Setting
|
Urbanization
|
Daily use of biomass fuels
|
Altitude
|
---|---|---|---|
Lima | Urban | Rare | Sea level |
Tumbes | Semi-urban | Moderately prevalent | Sea level |
Puno, urban | Urban | Rare | 3,825 meters above sea level |
Puno, rural | Rural | Highly prevalent | 3,825 meters above sea level |
Results
Participant characteristics
Lima
|
Urban Puno
|
Rural Puno
|
Tumbes
|
Overall
|
P
| |
---|---|---|---|---|---|---|
998 (33.8)
|
507 (17.2)
|
506 (17.1)
|
946 (32.0)
|
2957
| ||
Age in years, median (IQR)
| 54.7 (45.5, 64.0) | 54.8 (44.9, 64.5) | 54.8 (45.1, 63.9) | 54.9 (45.0, 64.8) | 54.8 (45.2, 64.3) | 0.87 |
Number of males (%)
| 492 (49.3) | 250 (49.3) | 240 (47.4) | 475 (50.2) | 1457 (49.3) | 0.80 |
Height in m, median (IQR)
| 1.54. (1.49, 1.61) | 1.57 (1.50, 1.63) | 1.55 (1.49, 1.62) | 1.58 (1.52, 1.65) | 1.56 (1.50, 1.63) | <0.001 |
BMI >30 kg/m
2
, n (%)
| 324 (32.5) | 133 (26.4) | 54 (10.8) | 299 (31.6) | 810 (27.5) | <0.001 |
Daily smoking, n (%)
| 32 (3.2) | 11 (2.2) | 1 (0.2) | 53 (5.6) | 97 (3.3) | <0.001 |
Rural origin, n (%)
| 510 (51.2) | 103 (20.5) | 481 (96.4) | 285 (30.2) | 1379 (46.9) | <0.001 |
Wealth index, n (%)
| ||||||
Low | 119 (11.9) | 120 (23.9) | 356 (70.4) | 307 (32.5) | 902 (30.6) | <0.001 |
Middle | 366 (36.7) | 129 (25.7) | 136 (26.9) | 387 (40.9) | 1018 (34.5) | |
High | 513 (51.4) | 254 (50.5) | 14 (2.8) | 252 (26.6) | 1033 (35.0) | |
Exposures, n (%)
| ||||||
Daily use of biomass fuels for cooking | 61 (6.1) | 25 (5.0) | 483 (96.6) | 221 (23.4) | 790 (26.8) | <0.001 |
Cooks indoors | 573 (57.8) | 436 (86.7) | 453 (90.8) | 497 (53.0) | 1959 (66.8) | <0.001 |
Clinical, (%)
| ||||||
History of tuberculosis | 69 (6.9) | 3 (0.6) | 7 (1.4) | 7 (0.7) | 86 (2.9) | <0.001 |
History of asthma | 82 (8.2) | 13 (2.6) | 3 (0.6) | 16 (1.7) | 114 (3.9) | <0.001 |
Family History of asthma | 146 (24.7) | 18 (3.6) | 8 (1.6) | 51 (7.9) | 223 (10.0) | <0.001 |
Family History of COPD | 4 (0.7) | 4 (0.8) | 0 | 0 | 8 (0.4) | 0.04 |
Variation in lung function measurements
Lima (n = 492)
|
Urban Puno (n = 250)
|
Rural Puno (n = 240)
|
Tumbes (n = 475)
|
P
| |
---|---|---|---|---|---|
FEV
1
(L)
| 3.4 (2.9–3.7) | 3.5 (3.0–4.0) | 3.5 (2.9–3.9) | 3.2 (2.8–3.6) | <0.001 |
FVC (L)
| 4.2 (3.7–4.7) | 4.4 (3.8–5.1) | 4.4 (3.9–5.0) | 4.0 (3.4–4.4) | <0.001 |
FEV
1
/height
2
(L/m
2
)
| 1.3 (1.1–1.4) | 1.3 (1.1–1.4) | 1.3 (1.1–1.5) | 1.2 (1.0–1.3) | <0.001 |
FVC/height
2
(L/m
2
)
| 1.6 (1.4–1.8) | 1.7 (1.5–1.9) | 1.7 (1.5–1.9) | 1.5 (1.3–1.6) | <0.001 |
FEV
1
/FVC (%)
| 80.0 (75.4–83.4) | 78.4 (74.9–82.3) | 77.8 (73.6–81.0) | 80.6 (77.4–84.0) | <0.001 |
Percent Predicted FEV
1
(%)
| |||||
GLI | 117.9 (107.5–129.8) | 119.9 (109.9–130.2) | 121.7 (111.5–133.9) | 107.7 (97.7–117.5) | <0.001 |
NHANES III | 113.3 (102.0–124.7) | 114.6 (105.2–124.2) | 117.0 (106.7–129.0) | 102.4 (92.6–112.0) | <0.001 |
Percent Predicted FVC (%)
| |||||
GLI | 120.1 (108.9–130.5) | 123.0 (112.8–134.3) | 126.2 (114.4–139.3) | 107.7 (98.3–116.0) | <0.001 |
NHANES III | 109.7 (99.8–119.5) | 112.3 (104.7–123.3) | 116.1 (105.6–128.1) | 98.7 (90.1–107.0) | <0.001 |
Lima (n = 506)
|
Urban Puno (n = 257)
|
Rural Puno (n = 266)
|
Tumbes (n = 471)
|
P
| |
---|---|---|---|---|---|
FEV
1
(L)
| 2.3 (2.0–2.6) | 2.4 (2.0–2.8) | 2.4 (2.0–2.8) | 2.2 (1.9–2.5) | <0.001 |
FVC (L)
| 2.8 (2.4–3.2) | 3.0 (2.5–3.5) | 3.0 (2.5–3.5) | 2.6 (2.3–2.9) | <0.001 |
FEV
1
/height
2
(L/m
2
)
| 1.0 (0.9–1.2) | 1.1 (0.9–1.2) | 1.1 (0.9–1.2) | 0.9 (0.8–1.1) | <0.001 |
FVC/height
2
(L/m
2
)
| 1.3 (1.1–1.4) | 1.3 (1.1–1.5) | 1.3 (1.2–1.5) | 1.1 (1.0–1.3) | <0.001 |
FEV
1
/FVC (%)
| 82.7 (79.3–85.3) | 80.5 (77.0–83.6) | 79.6 (75.6–82.5) | 83.0 (79.7–86.1) | <0.001 |
Percent predicted FEV
1
(%)
| |||||
GLI | 112.0 (102.1–123.7) | 115.2 (106.1–126.5) | 113.9 (102.3–126.0) | 103.1 (93.8–112.0) | <0.001 |
NHANES III | 106.2 (96.9–117.2) | 110.4 (100.7–119.7) | 107.5 (96.5–118.4) | 96.5 (88.5–105.5) | <0.001 |
Percent predicted FVC (%)
| |||||
GLI | 111.7 (100.3–122.1) | 119.2 (106.4–129.2) | 116.9 (104.7–128.3) | 101.1 (93.2–109.9) | <0.001 |
NHANES III | 103.4 (92.8–113.0) | 110.5 (98.3–119.1) | 107.6 (96.7–118.4) | 93.1 (85.5–100.8) | <0.001 |
Variation in COPD prevalence
Lima
|
Urban Puno
|
Rural Puno
|
Tumbes
|
Overall
|
P
| |
---|---|---|---|---|---|---|
(n = 998)
|
(n = 507)
|
(n = 506)
|
(n = 946)
| |||
COPD prevalence (95% CI)
| 6.2 (4.7–7.7) | 6.1 (4.0–8.2) | 9.9 (7.3–12.5) | 3.6 (2.4–4.8) | 6.0 (5.1–6.8) | <0.001 |
GOLD class by GLI, n (%)
| ||||||
I
| 43 (69.4) | 26 (83.9) | 38 (76.0) | 21 (61.7) | 128 (72.3) | 0.29 |
II
| 16 (25.8) | 5 (16.1) | 12 (24.0) | 11 (32.4) | 44 (24.9) | |
III
| 3 (4.8) | 0 | 0 | 2 (5.9) | 5 (2.8) | |
GOLD class by NHANES III, n (%)
| ||||||
I
| 42 (67.7) | 24 (77.4) | 38 (76.0) | 19 (55.9) | 123 (69.5) | 0.26 |
II
| 17 (27.4) | 7 (22.6) | 12 (24.0) | 13 (38.2) | 49 (27.8) | |
III
| 3 (4.8) | 0 | 0 | 2 (5.9) | 5 (2.8) | |
Post-bronchodilator response in COPD, n (%)
| 22 (36%) | 8 (26%) | 13 (26%) | 9 (27%) | 52 (29%) | 0.63 |
Post-bronchodilator response in non-COPD, n (%)
| 99 (11%) | 57 (12%) | 78 (17%) | 73 (8%) | 307 (11%) | <0.001 |
Risk factors associated with COPD
Prevalence ratio
|
95% CI
|
P
| |
---|---|---|---|
Age (per 10 years)
| 1.93 | 1.71–2.17 | <0.001 |
Male vs. Female Sex
| 2.35 | 1.61–3.42 | <0.001 |
Height (cm)
| 1.01 | 0.99–1.02 | 0.27 |
High Altitude vs. sea-level
| 1.61 | 0.92–2.82 | 0.10 |
≥10 pack-years of smoking
| 2.51 | 1.65–3.80 | <0.001 |
Urbanization
| |||
Urban | 1.00 | ||
Semi-Urban | 0.58 | 0.57–0.58 | <0.001 |
Rural | 1.57 | 1.56–1.59 | <0.001 |
Post-treatment pulmonary tuberculosis
| 4.27 | 3.09–5.88 | <0.001 |
Asthma
| 2.49 | 1.59–3.88 | <0.001 |
Biomass use at least once daily
| 1.68 | 1.25–2.25 | 0.001 |
Wealth Index
| |||
Low | 1.00 | ||
Middle | 0.81 | 0.50–1.30 | 0.38 |
High | 0.53 | 0.33–0.87 | 0.01 |
Males (n = 1443)
|
Females (n = 1487)
| |||||
---|---|---|---|---|---|---|
Prevalence ratio
|
95% CI
|
P
|
Prevalence ratio
|
95% CI
|
P
| |
Age (per 10 years)
| 1.65 | 1.42–1.92 | <0.001 | 2.51 | 1.86–3.38 | <0.001 |
High altitude vs. sea-level
| 1.13 | 1.06–1.21 | <0.001 | 1.44 | 1.05–1.99 | 0.02 |
≥10 pack-years of smoking
| 1.80 | 1.40–2.32 | <0.001 | 2.39 | 0.59–9.63 | 0.22 |
Urbanization
| ||||||
Urban | 1.00 | 1.00 | ||||
Semi-Urban | 0.52 | 0.43–0.64 | <0.001 | 0.66 | 0.53–0.82 | <0.001 |
Rural | 1.01 | 0.74–1.37 | 0.97 | 1.71 | 1.47–1.99 | <0.001 |
Post-treatment pulmonary tuberculosis
| 3.12 | 2.02–4.83 | <0.001 | 7.02 | 3.63–13.59 | <0.001 |
Asthma
| 2.16 | 1.11–4.23 | 0.02 | 2.30 | 1.12–4.72 | 0.02 |
Biomass use at least once daily
| 1.08 | 0.55–2.11 | 0.82 | 2.22 | 1.02–4.81 | 0.04 |
Wealth index
| ||||||
Low | 1.00 | 1.00 | ||||
Middle | 1.02 | 0.69–1.52 | 0.91 | 1.78 | 0.52–6.00 | 0.36 |
High | 0.68 | 0.39–1.19 | 0.18 | 1.44 | 0.54–3.86 | 0.47 |