{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T18:17:03Z","timestamp":1775672223542,"version":"3.50.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The Global Burden of Disease program identified smoking and ambient and household air pollution as the main drivers of death and disability from chronic obstructive pulmonary disease (COPD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged \u226540, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a postbronchodilator FEV1-to-FVC ratio less than the lower limit of normal, and the relative risks associated with different risk factors. Local relative risks were estimated using a Bayesian hierarchical model borrowing information from across sites. From these relative risks and the prevalence of risk factors, we estimated local population attributable risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>The mean prevalence of CAO was 11.2% in men and 8.6% in women. The mean population attributable risk for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for \u226510 years, low body mass index, and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although smoking remains the most important risk factor for CAO, in some areas, poor education, low body mass index, and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202005-1990oc","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T18:37:40Z","timestamp":1605033460000},"page":"1353-1365","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":85,"title":["Prevalence and Population-Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study"],"prefix":"10.1093","volume":"203","author":[{"given":"Peter","family":"Burney","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute and"}]},{"given":"Jaymini","family":"Patel","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute and"}]},{"given":"Cosetta","family":"Minelli","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute and"}]},{"given":"Louisa","family":"Gnatiuc","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-9449","authenticated-orcid":false,"given":"Andr\u00e9 F. S.","family":"Amaral","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute and"}]},{"given":"Ali","family":"Kocaba\u015f","sequence":"additional","affiliation":[{"name":"Department of Chest Diseases, Cukurova University School of Medicine, Adana, Turkey"}]},{"given":"Hamid Hacene","family":"Cherkaski","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Faculty of Medicine and University Hospital Annaba, Annaba, Algeria"}]},{"given":"Amund","family":"Gulsvik","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Institute of Medicine, University of Bergen, Bergen, Norway"}]},{"given":"Rune","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Institute of Medicine, University of Bergen, Bergen, Norway"}]},{"given":"Eric","family":"Bateman","sequence":"additional","affiliation":[{"name":"University of Cape Town Lung Institute, Cape Town, South Africa"}]},{"given":"Anamika","family":"Jithoo","sequence":"additional","affiliation":[{"name":"University of Cape Town Lung Institute, Cape Town, South Africa"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8118-8871","authenticated-orcid":false,"given":"Kevin","family":"Mortimer","sequence":"additional","affiliation":[{"name":"The Malawi Liverpool Wellcome Trust, Blantyre, Malawi"}]},{"given":"Talant M.","family":"Sooronbaev","sequence":"additional","affiliation":[{"name":"Pulmonology and Allergology Department, National Centre of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan"}]},{"given":"Herv\u00e9","family":"Lawin","sequence":"additional","affiliation":[{"name":"Unit of Teaching and Research in Occupational and Environmental Health, Cotonou, Benin"}]},{"given":"Chakib","family":"Nejjari","sequence":"additional","affiliation":[{"name":"Laboratoire d\u2019\u00e9pid\u00e9miologie, Recherche Clinique et Sant\u00e9 Communautaire, F\u00e8s, Morocco"}]},{"given":"Mohammed","family":"Elbiaze","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, University Hospital, Fes, Morocco"}]},{"given":"Karima","family":"El Rhazi","sequence":"additional","affiliation":[{"name":"Laboratoire d\u2019\u00e9pid\u00e9miologie, Recherche Clinique et Sant\u00e9 Communautaire, F\u00e8s, Morocco"}]},{"given":"Jin-Ping","family":"Zheng","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China"}]},{"given":"Pixin","family":"Ran","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China"}]},{"given":"Tobias","family":"Welte","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Hannover Medical School and German Center of Lung Research, Hannover, Germany"}]},{"given":"Daniel","family":"Obaseki","sequence":"additional","affiliation":[{"name":"Obafemi Awolowo University, Ile-Ife, Nigeria"}]},{"given":"Gregory","family":"Erhabor","sequence":"additional","affiliation":[{"name":"Obafemi Awolowo University, Ile-Ife, Nigeria"}]},{"given":"Asma","family":"Elsony","sequence":"additional","affiliation":[{"name":"The Epidemiological Laboratory, Khartoum, Sudan"}]},{"given":"Nada Bakri","family":"Osman","sequence":"additional","affiliation":[{"name":"The Epidemiological Laboratory, Khartoum, Sudan"}]},{"given":"Rana","family":"Ahmed","sequence":"additional","affiliation":[{"name":"The Epidemiological Laboratory, Khartoum, Sudan"}]},{"given":"Ewa","family":"Nizankowska-Mogilnicka","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Diseases, Department of Medicine, Jagiellonian University School of Medicine, Krak\u00f3w, Poland"}]},{"given":"Filip","family":"Mejza","sequence":"additional","affiliation":[{"name":"2nd Department of Internal Medicine, Center for Evidence Based Medicine, Jagiellonian University Medical College, Krak\u00f3w, Poland"}]},{"given":"David M.","family":"Mannino","sequence":"additional","affiliation":[{"name":"University of Kentucky, Lexington, Kentucky"}]},{"given":"Cristina","family":"B\u00e1rbara","sequence":"additional","affiliation":[{"name":"Institute of Environmental Health, Lisbon Medical School, Lisbon University, Lisbon, Portugal"}]},{"given":"Emiel F. 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