Chest
Volume 129, Issue 4, April 2006, Pages 879-885
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Original Research
Seven-Year Cumulative Incidence of COPD in an Age-Stratified General Population Sample

https://doi.org/10.1378/chest.129.4.879Get rights and content

Aim

To estimate the cumulative incidence of COPD and risk factors related to the development of COPD, including evaluation of the relationship between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 (ie, respiratory symptoms and normal lung function) and the development of COPD, in an age-stratified general population sample of middle-aged and elderly individuals.

Method

The third survey of the Obstructive Lung Disease in Northern Sweden studies cohort I (three age strata born in 1919 to 1920, 1934 to 1935, and 1949 to 1950) was performed in 1996, and 5,189 subjects (88%) responded to the postal questionnaire. Of the responders, a random sample (1,500 subjects) was invited to an examination in 1996 and in 2003. A total of 963 subjects performed spirometry on both occasions. COPD was defined according to the spirometric criteria of the GOLD. Two levels of disease severity, grade I and higher (GOLD criteria, FEV1/FVC ratio of < 0.70) and also grade II and higher (GOLD II criteria, FEV1/FVC ratio of < 0.70 and FEV1 <80% predicted).

Results

The 7-year cumulative incidence of COPD was 11.0% and 4.9%, respectively, according to GOLD and GOLD II, and was significantly related to smoking (smokers, 18.8% and 10.6%, respectively; ex-smokers, 10.5% and 5.2%, respectively; non-smokers, 7.6% and 1.6%, respectively). Incident COPD according to GOLD, but not according to GOLD II, was significantly associated with increasing age. Most respiratory symptoms at study entry were markers of increased risk for incident COPD when analyzed in a multivariate model adjusting for confounders.

Conclusion

The GOLD criteria yielded a higher cumulative incidence (11.0%) compared to the GOLD II (4.9%). Smoking, but not gender, was associated with incident COPD. Most respiratory symptoms at the beginning of the observation period marked an increased risk for developing COPD, thus the classification GOLD stage 0 seems relevant among middle-aged and elderly persons.

Section snippets

Study Population

The Obstructive Lung Disease in Northern Sweden (OLIN) studies have collected epidemiologic data since 1985 to 1986 with a focus on allergy and obstructive lung disease (OLD).415161718 This study is a follow-up of the first OLIN cohort that was recruited in 1985 to 1986, when a postal questionnaire was sent to all 6,610 subjects born in 1919 to 1920 (age group I), 1934 to 1935 (age group II), and 1949 to 1950 (age group III) in eight representative areas of northern Sweden.16 In 1996, the

Incidence of COPD

During the observation period of 7 years, COPD developed in 45 subjects (25 women) according to the GOLD II criteria and in 91 subjects (52 women) according to the GOLD criteria, which corresponds to a cumulative incidence of 4.9% (95% CI, 3.6 to 6.5) and 11.0% (95% CI, 9.0 to 13.4), respectively. The cumulative incidence was significantly associated with smoking. The cumulative incidence of COPD (GOLD II criteria) was more than six times higher among smokers (10.8%) compared to nonsmokers

Discussion

The 7-year cumulative incidence of COPD was estimated at 4.9% and 11.0%, respectively, according to the spirometric criteria of GOLD II and GOLD, and was strongly associated with smoking but not gender. The cumulative incidence of COPD according to GOLD criteria, but not according to GOLD II criteria, was associated with increasing age. The cumulative incidence of COPD according to GOLD II criteria corresponds to an annual incidence rate of 7 per 1,000 persons per year in the total population,

ACKNOWLEDGMENT

The research assistants Linnea Hedman, Ann-Christin Jonsson, and Sigrid Sundberg, and statistician Ola Bernhoff are acknowledged for collecting and entering the data into the computerized database.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This research was supported by The Swedish Heart-Lung Foundation and the Norrbotten′s Health Care Authority. The GlaxoSmithKline R&D department is acknowledged for additional financial support.

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