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Vol. 54. Num. 5.May 2018
Pages 241-300
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Vol. 54. Num. 5.May 2018
Pages 241-300
Original Article
DOI: 10.1016/j.arbr.2017.09.017
Prevalence of COPD in 6 Urban Clusters in Argentina: The EPOC.AR Study
Prevalencia de enfermedad pulmonar obstructiva crónica en 6 aglomerados urbanos de Argentina: el estudio EPOC.AR
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Andrés L. Echazarretaa,
Corresponding author
aechaza@gmail.com

Corresponding author.
, Sergio J. Ariasb, Ricardo del Olmoc, Eduardo R. Giugnod, Federico D. Colodencoc, Santiago C. Arcee, Juan C. Bossiob, Gustavo Armandob, Joan B. Sorianof, Grupo de estudio EPOC.AR
a Hospital Interzonal Especializado de Agudos y Crónicos San Juan de Dios, La Plata, Argentina
b Instituto Nacional de Enfermedades Respiratorias Emilio Coni, Ministerio de Salud de la Nación, Santa Fe, Argentina
c Hospital María Ferrer , Ciudad Autónoma de Buenos Aires, Argentina
d Hospital Dr. Antonio A. Cetrángolo, Zona Norte de Gran Buenos Aires, Argentina
e Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
f Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
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Tables (5)
Table 1. Participant characteristics.
Table 2. Spirometric characteristics of participants (n: 3469).
Table 3. COPD prevalence. Distribution by cluster, sex, age, education, and socioeconomic status.
Table 4. COPD prevalence by age group, obstruction, exposure, symptoms, and spirometric criteria.
Table 5. COPD prevalence according to selected criteria: Number and percentages by category, crude OR, and OR adjusted by logistic regression for each category.
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Abstract
Introduction

The prevalence of chronic obstructive pulmonary disease (COPD) has not been studied in Argentina.

Objectives

To determine the prevalence and relevant clinical characteristics of COPD in a representative sample.

Material and methods

We performed a cross-sectional study in a population of adults aged ≥40 years randomly selected by cluster sampling in 6 urban locations. Subjects answered a structured survey and performed pre- and post-bronchodilator spirometry (PBD). COPD was defined as FEV1/FVC ratio <0.7 predicted value. The total prevalence was estimated for each cluster with its 95% confidence interval (CI).

Results

Of 4599 surveys and 3999 spirometries, 3469 were considered of adequate quality (86.8%) for our study. The prevalence of COPD was 14.5% (CI: 13.4–15.7). The distribution of COPD cases according to FEV1 (GOLD 2017) was stage 1: 38% (CI: 34–43); stage 2: 52% (CI: 47–56); stage 3: 10% (CI: 7–13); and stage 4: 1% (CI: 0–2), and according to the refined ABCD (GOLD 2017) assessment: A: 52% (CI: 47–56); B: 43% (CI: 39–48); C: 1% (CI: 0–2); D: 4% (CI: 2–6). The rate of underdiagnosis was 77.4% (CI: 73.7%–81.1%) and diagnostic error 60.7% (CI: 55.1%–66.3%). A significant association was found between COPD and age (OR 3.77 in individuals 50–59 years of age and 19.23 in those >80 years), male gender (OR 1.62; CI: 1.31–2), smoking (OR 1.95; CI: 1.49–2.54), low socioeconomic status (OR 1.33; CI: 1.02–1.73), and previous tuberculosis (OR 3.3; CI: 1.43–7.62).

Conclusions

We estimate that more than 2.3 million Argentineans have COPD, with high rates of underdiagnosis and diagnostic error.

Keywords:
COPD
EPOC.AR
Argentina
Prevalence
Smoking
Resumen
Introducción

La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) en Argentina no había sido estudiada.

Objetivos

Determinar la prevalencia de EPOC y rasgos clínicos relevantes en una muestra representativa.

Material y métodos

Estudio de corte transversal en población ≥40 años en 6 aglomerados urbanos seleccionada aleatoriamente mediante muestreo por conglomerados. Se aplicó una encuesta estructurada y espirometrías pre y postbroncodilatador (PBD). Se definió EPOC en quienes presentaban un cociente FEV1/FVC PBD <0,7. Se estimó la prevalencia total y para cada aglomerado con intervalo de confianza del 95% (IC).

Resultados

Se realizaron 4.599 encuestas y 3.999 espirometrías, de las cuales 3.469 fueron útiles (86,8%). La prevalencia de EPOC fue de 14,5% (IC: 13,4-15,7). La distribución de los casos compatibles con EPOC según FEV1 (GOLD-2017) fue: 1: 38% (IC: 34-43); 2: 52% (IC: 47-56); 3: 10% (IC: 7-13); y 4: 1% (IC: 0,-2) y de acuerdo al modelo combinado ABCD (GOLD 2017): A: 52% (IC: 47-56); B: 43% (IC: 39-48); C: 1% (IC: 0-2) y D: 4% (IC: 2-6). El subdiagnóstico fue del 77,4% (IC 73,7-81,1%) y el error diagnóstico de 60,7% (IC 55,1-66,3%). Encontramos asociación significativa de presencia de EPOC con edad (OR 3,77 en 50-59 años a 19,23 en >80 años), sexo masculino (OR: 1,62; IC: 1,31-2), tabaquismo (OR: 1,95; IC: 1,49-2,54), nivel socieconómico bajo (OR: 1,33; IC: 1,02-1,73) y antecedentes de tuberculosis (OR: 3,3; IC: 1,43-7,62).

Conclusiones

Se estima que más de 2,3 millones de argentinos padecen EPOC con elevada tasa de subdiagnóstico y error diagnóstico.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
EPOC.AR
Argentina
Prevalencia
Tabaquismo

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