Epidemiology of Chronic Obstructive Pulmonary Disease in Brazil: a systematic review and meta-analysis

Cruz, Marina Malheiro; Pereira, Marcos

doi:10.1590/1413-812320202511.00222019

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Sumário

REVIEW • Ciênc. saúde coletiva 25 (11) • Nov 2020 • https://doi.org/10.1590/1413-812320202511.00222019 copy

Epidemiology of Chronic Obstructive Pulmonary Disease in Brazil: a systematic review and meta-analysis

Epidemiologia da Doença Pulmonar Obstrutiva Crônica no Brasil: uma revisão sistemática e metanálise

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of morbidity and mortality in developing countries; however, few systematic reviews are available in the literature. This review examines the prevalence of COPD in the Brazilian population. For this purpose, a systematic review and meta-analysis was conducted of epidemiological observational studies indexed in the databases PubMed, Cochrane, Ovid, Scopus, ScienceDirect, SciELO, Lilacs, and Google Scholar published up to May 2018. The prevalence was estimated using a random effects model. Of the 1,182 articles identified, 12 were eligible. The prevalence of COPD in Brazil was 17% (95%CI: 13-22; I² = 94%) and the region with the highest prevalence of COPD was the Center-western region (25%), followed by the Southeastern region (23%). The Southern region had the lowest prevalence among the studies (12%). We found that Brazil has a high occurrence of COPD, higher than the estimates of Latin American and world population Hence, additional studies are necessary to support intervention strategies, as well as formulation of specific public health policies to control and prevent COPD.

Key words
Prevalence; COPD; Brazil; Epidemiological surveys; Review

Database	Search strategy	Items found
PubMed	("Pulmonary Disease, Chronic Obstructive"[Mesh] OR ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields])) AND "Brazil"[Mesh]	181
Web of science	# 1 TS = COPD = 47.491 # 2 TS = Pulmonary Disease, Chronic Obstructive = 44.859 # 3 TS= Brazil = 183.324 # 4 #3 AND #2 AND #1 =76	76
Scopus	("Pulmonary Disease, Chronic Obstructive" OR copd AND Brazil)	203
Science Direct	"Pulmonary Disease, Chronic Obstructive" OR "COPD" AND "Brazil" AND "Observational studies"	355
SciELO	doenca pulmonar obstrutiva cronica AND Brasil	73
Ovid	# 1 Pulmonary Disease, Chronic Obstructive/ = 32366 # 2 COPD.mp. = 32826 # 3 Brazil.mp. or BRAZIL/ = 91298 # 4 1 or 2 = 41970 # 5 3 and 4 = 176	176
BVS	chronic obstructive pulmonary disease or COPD and Brazil	113
CAPES	Descriptors: Chronic obstructive pulmonary disease prevalence in Brazill (filters: health sciences, public health, medicine, pneumology, medicine (pneumology);): 494 results	494
Pulmonology and COPD	4 (2010, 2012, 2014, 2017)	4

Authors, Year	Location	Type	Sample	Year of collection	Mean age	Prevalence of COPD	Meta-analysis
Queiroz et al, 2012²⁵25 Queiroz MCC, Carmo Moreira MA, Rabahi MF, Queiroz MCCAM, Moreira MAC, Rabahi MF. Underdiagnosis of COPD at primary health care clinics in the city of Aparecida de Goiania, Brazil. J Bras Pneumol 2012; 38(6):692-699.	Aparecida de Goiânia - GO	Cross-section	200	2011	66	31	Yes
Moreira et al., 2013³⁹39 Moreira MAC, Barbosa MA, Jardim JR, Queiroz MCC, Inácio LU. Chronic obstructive pulmonary disease in women exposed to wood stove smoke. Rev Assoc Med 2013; 59(6):607-613.	Goiânia - GO	Cross-section	160	-	70	26	Yes
Carvalho et al., 2012²⁴24 Carvalho AK, Menezes AMB, Camelier A, Rosa FW, Nascimento OA, Perez-Padilla R, Jardim JR. Prevalence of self-reported chronic diseases in individuals over the age of 40 in São Paulo, Brazil: The PLATINO study. Cad Saude Publica 2012; 28(5):905-912.	São Paulo - SP	Cross-section	918	-	55	16	Yes
Menezes et al., 2005²2 Menezes AMB, Perez-Padilla R, Jardim JRB, Muino A, Lopez MV, Valdivia G, PLATINO Team. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005; 366(9500):1875-1881.	São Paulo - SP	Cross-section	963	2003-2004	55	16	Yes
Rabahi et al., 2015²³23 Rabahi M, Pereira SA, Rodrigues Junior JL, Rezende AP, Costa AC, Corrêa KS, Conde MB. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms. Int J Chron Obstruct Pulmon Dis 2015; 10:1525-1529.	Goiânia - GO	Cross-section	316	2011-2012	68	16	Yes
Landis et al., 2014⁴⁰40 Landis SH, Muellerova H, Mannino DM, Menezes AM, Han MK, van der Molen T, Ichinose M, Aisanov Z, Oh YM, Davis KJ. Continuing to confront COPD international patient survey: Methods, COPD prevalence, and disease burden in 2012-2013. Int J Chron Obstruct Pulmon Dis 2014; 9:597-607.	Brazil	Cross-section	300	2012-2013	40-49	12	Yes
Menezes et al., 2004¹²12 Menezes A, Macedo SC, Gigante DP, da Costa JD, Olinto MT, Fiss E, Chatkin M, Hallal PC, Victora CG. Prevalence and risk factors for chronic obstructive pulmonary disease according to symptoms and spirometry. COPD 2004; 1(2):173-179.	Pelotas -RS	Cross-section	191	2001	40-49	15	Yes
Souza et al., 2010²⁹29 Souza RM, Andrade FM, Moura ABD, Teixeira PJZ. Respiratory symptoms in charcoal production workers in the cities of Lindolfo Collor, Ivoti and Presidente Lucena, Brazil. J Bras Pneumol 2010; 36(2):210-217.	Lindolfo Collor, Presidente Lucena and Ivoti - RS	Cross-section	67	2007	46	6	Yes
Cavalli, 2015⁴¹41 Cavalli F. Of Chronic Obstructive Pulmonary Disease Prevalence of COPD In Florianopolis and associated factors: population based study [dissertation]. Florianópolis: UFSC; 2015.	Florianópolis - SC	Cross-section	1059	2010-2013	65	9	Yes
Pisoni, 2007³⁶36 Pisoni TM. Prevalência da doença pulmonar obstrutiva crônica (DPOC) e fatores de risco ambientais nos bairros mais populosos de Novo Hamburgo [dissertation]. Novo Hamburgo: Centro Universitário Feevale; 2007.	Novo Hamburgo - RS	Cross-section	186	2005-2006	40-49	4	Yes
Kaisermann, 2006³⁷37 Kaisermann M. XXXIII Congresso Brasileiro de Pneumologia e Tisiologia 2006. 2006; 238(Supl. 5):104.	Rio de Janeiro - RJ	Cross-section	117	2005-2006	>40	46	Yes
Santos et al., 2014³⁸38 Santos SR, Lizzi ES, Vianna EO. Characteristics of undiagnosed COPD in a senior community center. Int J Chron Obstruct Pulmon Dis 2014; 9:1155-1161.	Uberaba - MG	Cross-section	335	2012	71	21	Yes
Menezes et al., 2008²⁸28 Menezes AMB, Perez-Padilla R, Hallal PC, Jardim JR, Muino A, Lopez MV, Valdivia G, Pertuza J, Oca MM, Tálamo C, PLATINO Team. Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study. Int J Tuberc Lung Dis 2008; 12(7):709-712.^,³⁴34 Menezes AM, Muiño A, López-Varela MV, Valdivia G, Lisboa C, Jardim JR, Montes de Oca M, Tálamo C, Wehrmeister FC, Perez-Padilla R; Equipo del estudio Platino. A population-based cohort study on chronic obstructive pulmonary disease in Latin America: methods and preliminary results. The PLATINO Study Phase II. Arch Bronconeumol 2014; 50(1):10-17.	São Paulo - SP	Cross-section	963	2003	>40	14	No
Carandina, 1986³¹31 Carandina L. Prevalence of symptoms suggesting unspecific chronic respiratory diseases in the urban population of Botucatu, São Paulo [thesis]. São Paulo: Universidade de São Paulo; 1986.	Botucatu - SP	Cross-section	7075	1983-1984	>15	0	No
Sousa et al., 2011⁴²42 Sousa CA, César CLG, Barros MBA, Carandina L, Goldbaum M, Pereira JCR. Doença pulmonar obstrutiva crônica e fatores associados em São Paulo, SP, 2008-2009. Rev Saude Publica 2011; 45(5):887-896.	São Paulo - SP	Cross-section	1441	2008-2009	>40	4	No
Carvalho et al., 1986³²32 Carvalho FM, Silvany Neto AM, Lima MEC. Diseases of the repiratory system in a population residing nearly a chocolate factory in Salvador, Bahia. Rev Baiana Saúde Pública 1986; 13(1/3):33-46.	Salvador - BA	Case-control	1562 exp 1351 con	1984	>50	RP=3	No
Deolinda et al., 2010³⁰30 Deolinda GZ, Yamane A, Souza FJFB, Filho AJS. Prevalência de pacientes internados com diagnóstico clínico e espirométrico de doença pulmonar obstrutiva crônica num hospital da região sul de Santa Catarina. J Bras Pneumol 2010; 36(Supl. 2R):92.	Criciúma - SC	Cross-section	6169	2009	-	4	No
Nascimento et al., 2007³³33 Nascimento OA, Camelier A, Rosa FW, Menezes AM, Pérez-Padilla R, Jardim JR, Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) Group. Chronic obstructive pulmonary disease is underdiagnosed and undertreated in São Paulo (Brazil): results of the PLATINO study. Braz J Med Biol Res 2007; 40(7):887-895	São Paulo - SP	Cross-section	918	2003	60	16	No
Talamo et al., 2007³⁵35 Tálamo C, Oca MM, Halbert R, Perez-Padilla R, Jardim JRB, Muiño A, Lopez MV, Valdivia G, Pertuzé J, Moreno D, Menezes AMB, PLATINO team. Diagnostic labeling of COPD in five Latin American cities. Chest 2007; 131(1):60-67.	São Paulo - SP	Cross-section	961	2003	64	14	No

Authors, Year	Hoy score
Queiroz et al., 2012²⁵25 Queiroz MCC, Carmo Moreira MA, Rabahi MF, Queiroz MCCAM, Moreira MAC, Rabahi MF. Underdiagnosis of COPD at primary health care clinics in the city of Aparecida de Goiania, Brazil. J Bras Pneumol 2012; 38(6):692-699.	8
Moreira et al., 2013³⁹39 Moreira MAC, Barbosa MA, Jardim JR, Queiroz MCC, Inácio LU. Chronic obstructive pulmonary disease in women exposed to wood stove smoke. Rev Assoc Med 2013; 59(6):607-613.	9
Carvalho et al., 2012²⁴24 Carvalho AK, Menezes AMB, Camelier A, Rosa FW, Nascimento OA, Perez-Padilla R, Jardim JR. Prevalence of self-reported chronic diseases in individuals over the age of 40 in São Paulo, Brazil: The PLATINO study. Cad Saude Publica 2012; 28(5):905-912.	9
Menezes et al., 2005²2 Menezes AMB, Perez-Padilla R, Jardim JRB, Muino A, Lopez MV, Valdivia G, PLATINO Team. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005; 366(9500):1875-1881.	9
Rabahi et al., 2015²³23 Rabahi M, Pereira SA, Rodrigues Junior JL, Rezende AP, Costa AC, Corrêa KS, Conde MB. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms. Int J Chron Obstruct Pulmon Dis 2015; 10:1525-1529.	6
Landis et al., 2014⁴⁰40 Landis SH, Muellerova H, Mannino DM, Menezes AM, Han MK, van der Molen T, Ichinose M, Aisanov Z, Oh YM, Davis KJ. Continuing to confront COPD international patient survey: Methods, COPD prevalence, and disease burden in 2012-2013. Int J Chron Obstruct Pulmon Dis 2014; 9:597-607.	9
Menezes et al., 2004¹²12 Menezes A, Macedo SC, Gigante DP, da Costa JD, Olinto MT, Fiss E, Chatkin M, Hallal PC, Victora CG. Prevalence and risk factors for chronic obstructive pulmonary disease according to symptoms and spirometry. COPD 2004; 1(2):173-179.	9
Souza et al., 2010²⁹29 Souza RM, Andrade FM, Moura ABD, Teixeira PJZ. Respiratory symptoms in charcoal production workers in the cities of Lindolfo Collor, Ivoti and Presidente Lucena, Brazil. J Bras Pneumol 2010; 36(2):210-217.	7
Cavalli, 2015⁴¹41 Cavalli F. Of Chronic Obstructive Pulmonary Disease Prevalence of COPD In Florianopolis and associated factors: population based study [dissertation]. Florianópolis: UFSC; 2015.	9
Pisoni, 2007³⁶36 Pisoni TM. Prevalência da doença pulmonar obstrutiva crônica (DPOC) e fatores de risco ambientais nos bairros mais populosos de Novo Hamburgo [dissertation]. Novo Hamburgo: Centro Universitário Feevale; 2007.	9
Kaisermann, 2006³⁷37 Kaisermann M. XXXIII Congresso Brasileiro de Pneumologia e Tisiologia 2006. 2006; 238(Supl. 5):104.	6
Santos et al., 2014³⁸38 Santos SR, Lizzi ES, Vianna EO. Characteristics of undiagnosed COPD in a senior community center. Int J Chron Obstruct Pulmon Dis 2014; 9:1155-1161.	8

Subgroup	Number of studies	Number of participants	Prevalence (%)	95%CI	I² (%)
Collection year
2000-2004	3	2072	20	14-26	0
2005-2007	3	370	18	1-38	0
2008-2015	6	2379	19	12-25	94.3
Sex
Male	8	1118	16	6-26	96.0
Female	6	1518	13	5-20	96.2
Risk of bias
Moderate	5	1035	24	13-34	94.5
Low	7	3777	16	11-21	95.5
Region of Brazil
Central-West	3	676	25	15-35	0
Southeast	4	2333	23	16-30	0
South	4	1503	12	04-20	95.35
Brazil	1	300	-	-	-

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[1] Collaborations

M Pereira and MM Cruz developed the study concept, draft of the manuscript and approved the final manuscript. M Pereira supervised the study process.