Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study

Andreas Horner*, Joan B. Soriano, Milo A. Puhan, Michael Studnicka, Bernhard Kaiser, Lowie E. G. W. Vanfleteren, Louisa Gnatiuc, Peter Burney, Marc Miravitlles, Francisco Garcia-Rio, Julio Ancochea, Ana M. Menezes, Rogelio Perez-Padilla, Maria Montes de Oca, Carlos A. Torres-Duque, Andres Caballero, Mauricio Gonzalez-Garcia, Sonia Buist, Maria Flamm, Bernd LamprechtBOLD Collaborative Research Group, EPI-SCAN Team, PLATINO Team, PREPOCOL Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors.

Methods: A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as > 1500 m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD.

Results: Among 30,874 participants aged 56.1 +/- 11.3 years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500 m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p <0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude.

Conclusion: Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.

Original languageEnglish
Article number162
Number of pages10
JournalRespiratory Research
Publication statusPublished - 23 Aug 2017


  • COPD
  • Geographical altitude
  • Risk factors
  • Underdiagnosis
  • Epidemiology


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