title: How does socioeconomic development affect COPD mortality? An age-period-cohort analysis from a recently transitioned population in China.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a leading cause of death, particularly in developing countries. Little is known about the effects of economic development on COPD mortality, although economic development may potentially have positive and negative influences over the life course on COPD. We took advantage of a unique population whose rapid and recent economic development is marked by changes at clearly delineated and identifiable time points, and where few women smoke, to examine the effect of macro-level events on COPD mortality.
  
  
  METHODS
  We used Poisson regression to decompose sex-specific COPD mortality rates in Hong Kong from 1981 to 2005 into the effects of age, period and cohort.
  
  
  RESULTS
  COPD mortality declined strongly over generations for people born from the early to mid 20th century, which was particularly evident for the first generation to grow up in a more economically developed environment for both sexes. Population wide COPD mortality decreased when air quality improved and increased with increasing air pollution. COPD mortality increased with age, particularly after menopause among women.
  
  
  CONCLUSIONS
  Economic development may reduce vulnerability to COPD by reducing long-lasting insults to the respiratory system, such as infections, poor nutrition and indoor air pollution. However, some of these gains may be offset if economic development results in increasing air pollution or increasing smoking.
authors.affiliation: Department of Community Medicine and School of Public Health, The University of Hong Kong, Hong Kong.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Catherine Mary
authors.initials: CM
authors.lastname: Schooling
authors.forename: Janice Mary
authors.initials: JM
authors.lastname: Johnston
authors.forename: Anthony Johnson
authors.initials: AJ
authors.lastname: Hedley
authors.forename: Sarah Morag
authors.initials: SM
authors.lastname: McGhee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality*; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors