Epidemiology

Whereas most epidemiological studies are based on information elicited by questionnaires or physiological tests, emphysema is a morphological diagnosis and epidemiological studies must be confined to autopsy data. Furthermore, the lungs must be properly fixed on inflation and examined using comparable techniques and emphysema grading methods. Perhaps because of a younger average age of the population examined and a lower prevalence of cigarette smoking, studies from Africa reveal a lower frequency of emphysema than elsewhere. Yet even when populations are of the same age, and the lungs are examined by the same investigators, there appear to be some national and even regional differences. For example, the frequency of emphysema is greater in parts of the United Kingdom than in Sweden or some parts of North America, and lower in some North American cities than in others. The frequency differences may reflect different patterns of cigarette smoking or levels of air pollution, or the selection of people autopsied. The various studies do agree that the amount and severity of emphysema increase with advancing age, and cigarette smoking is a primary cause of the disease. In the various studies, emphysema is found, and in more severe form, at least twice as often in men as in women. The greater incidence of emphysema in males may reflect the greater prevalence of smoking in men; if that is the case, then as more women take up cigarette smoking, this sex preference may change. Although emphysema is remarkably common, it is a cause of, or contributes to, death in only a small percentage of cases.

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