title: [Geographical variations in the prevalence of COPD in Spain: relationship to smoking, death rates and other determining factors].
abstract: BACKGROUND
  The EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain.
  
  
  OBJECTIVE
  We studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV₁/FVC ratio <0.70 or as the lower limit of normal (LLN).
  
  
  RESULTS
  The ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P<0.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9-6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P<0.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P<0.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities.
  
  
  CONCLUSIONS
  There are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment.
authors.affiliation: Fundación Caubet-CIMERA, Illes Balears, España. jbsoriano@caubet-cimera.es
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.forename: Luis
authors.initials: L
authors.lastname: Borderías
authors.forename: Enric
authors.initials: E
authors.lastname: Duran-Tauleria
authors.forename: Francisco
authors.initials: F
authors.lastname: García Río
authors.forename: Jaime
authors.initials: J
authors.lastname: Martínez
authors.forename: Teodoro
authors.initials: T
authors.lastname: Montemayor
authors.forename: Luis
authors.initials: L
authors.lastname: Muñoz
authors.forename: Luis
authors.initials: L
authors.lastname: Piñeiro
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Sánchez
authors.forename: Joan
authors.initials: J
authors.lastname: Serra
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Soler-Cataluña
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.forename: Jose
authors.initials: J
authors.lastname: Luis Viejo
authors.forename: Víctor
authors.initials: V
authors.lastname: Sobradillo-Peña
authors.forename: Julio
authors.initials: J
authors.lastname: Ancochea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012907:Smoking; D013030:Spain / Q000453:epidemiology