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Regional variations in the prevalence and misdiagnosis of air flow obstruction in China: baseline results from a prospective cohort of the China Kadoorie Biobank (CKB)
  1. Om P Kurmi1,
  2. Liming Li2,3,
  3. Margaret Smith1,
  4. Mareli Augustyn1,
  5. Junshi Chen4,
  6. Rory Collins1,
  7. Yu Guo2,
  8. Yabin Han5,
  9. Jingxin Qin6,
  10. Guanqun Xu7,
  11. Jian Wang8,
  12. Zheng Bian2,
  13. Gang Zhou9,
  14. Kourtney Davis10,
  15. Richard Peto1,
  16. Zhenming Chen1,
  17. on behalf of the China Kadoorie Biobank Collaborative Group
  1. 1Nuffield Department of Population, University of Oxford, Oxford, UK
  2. 2School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China
  3. 3Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
  4. 4China National Center for Food Safety Risk Assessment, Beijing, People's Republic of China
  5. 5Tongxiang Center for Disease Control, Tongxiang, Zhejiang, People's Republic of China
  6. 6Liuzhou Center for Disease Control, Liuzhou, Guangxi, People's Republic of China
  7. 7Suzhou Center for Disease Control, Suzhou, Jiangsu, People's Republic of China
  8. 8Pengzhou Center for Disease Control, Pengzhou, Sichuan, People's Republic of China
  9. 9Henan Center for Disease Control, Zhengzhou, Henan, People's Republic of China
  10. 10Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK
  1. Correspondence to Dr Om P Kurmi; om.kurmi{at}


Background Despite the great burden of chronic respiratory diseases in China, few large multicentre, spirometry-based studies have examined its prevalence, rate of underdiagnosis regionally or the relevance of socioeconomic and lifestyle factors.

Methods We analysed data from 512 891 adults in the China Kadoorie Biobank, recruited from 10 diverse regions of China during 2004–2008. Air flow obstruction (AFO) was defined by the lower limit of normal criteria based on spirometry-measured lung function. The prevalence of AFO was analysed by region, age, socioeconomic status, body mass index (BMI) and smoking history and compared with the prevalence of self-reported physician-diagnosed chronic bronchitis or emphysema (CB/E) and its symptoms.

Findings The prevalence of AFO was 7.3% in men (range 2.5–18.2%) and 6.4% in women (1.5–18.5%). Higher prevalence of AFO was associated with older age (p<0.0001), lower income (p<0.0001), poor education (p<0.001), living in rural regions (p<0.001), those who started smoking before the age of 20 years (p<0.001) and low BMI (p<0.001). Compared with self-reported diagnosis of CB/E, 88.8% of AFO was underdiagnosed; underdiagnosis proportion was highest in 30–39-year olds (96.7%) compared with the 70+ age group (81.1%), in women (90.7%), in urban areas (89.4%), in people earning 5K–10 K ¥ monthly (90.3%) and in those with middle or high school education (92.6%).

Interpretation In China, the burden of AFO based on spirometry was high and significantly greater than that estimated based on self-reported physician-diagnosed CB/E, especially in rural areas, reflecting major issues with diagnosis of AFO that will impact disease treatment and management.

  • COPD Epidemiology
  • Tobacco and the Lung

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