Arch Bronconeumol. 2010;46(10):522-530 Órgano Oficial de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Asociación Latinoamericana del Tórax (ALAT) y la Asociación Iberoamericana de Cirugía Torácica (AICT) Volumen 45, Número 1, Enero 2009 Originales Revisión Normativa SEPAR Archivos de Bronconeumología 0300-2896/$ - see front matter © 2010 SEPAR. Published by Elsevier España, S.L. All rights reserved. www.archbronconeumol.org Original Article Geographical Variations in the Prevalence of COPD in Spain: Relationship to Smoking, Death Rates and other Determining Factors Joan B. Soriano, a, * Marc Miravitlles, b Luis Borderías, c Enric Duran-Tauleria, d Francisco García Río, e Jaime Martínez, f Teodoro Montemayor, g Luis Muñoz, h Luis Piñeiro, i Guadalupe Sánchez, j Joan Serra, k Juan José Soler-Cataluña, l Antoni Torres, m Jose Luis Viejo, n Víctor Sobradillo-Peña, o and Julio Ancochea p a Fundación Caubet-CIMERA, Balearic Islands, Spain b Fundació Clínic Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain c Hospital San Jorge, Huesca, Spain d Institut Municipal d’Investigació Mèdica (IMIM) Hospital del Mar, Barcelona, Spain e Hospital La Paz, IdiPAZ, Madrid, Spain f Hospital Central de Asturias, Oviedo, Spain g Hospital Virgen de la Macarena, Seville, Spain h Hospital Reina Sofía, Córdoba, Spain i Hospital Xeral Cies, Vigo, Spain j Departamento Médico, GlaxoSmithkline S.A., Madrid, Spain k Hospital General de Vic, Vic, Barcelona, Spain l Hospital General de Requena, Requena, Valencia, Spain m Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS and CIBER de Enfermedades Respiratorias, Spain n Hospital General Yagüe, Burgos, Spain o Hospital de Cruces, Bilbao, Spain p Hospital La Princesa Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain ARTICLE INFO Article history: Received April 20, 2010 Accepted June 16, 2010 Keywords: EPI-SCAN COPD Spain Smoking Variation 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. Objectives: 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 FEV 1 / 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<.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<.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<.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. Conclusion: There are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment. © 2010 SEPAR. Published by Elsevier España, S.L. All rights reserved. * Corresponding author. E-mail address: jbsoriano@caubet-cimera.es (J.B. Soriano).