The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. There are also disparities among races and between men and women in the incidence of sepsis. Gram-positive bacteria and fungal organisms are increasingly common causes of sepsis.

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The aim of this study was to quantify the global prevalence of chronic obstructive pulmonary disease (COPD) by means of a systematic review and random effects meta-analysis.PubMed was searched for population-based prevalence estimates published during the period 1990-2004. Articles were included if they: 1) provided total population or sex-specific estimates for COPD, chronic bronchitis and/or emphysema; and 2) gave method details sufficiently clearly to establish the sampling strategy, approach to diagnosis and diagnostic criteria.Of 67 accepted articles, 62 unique entries yielded 101 overall prevalence estimates from 28 different counties. The pooled prevalence of COPD was 7.6% from 37 studies, of chronic bronchitis alone (38 studies) was 6.4% and of emphysema alone (eight studies) was 1.8%. The pooled prevalence from 26 spirometric estimates was 8.9%. The most common spirometric definitions used were those of the Global Initiative for Chronic Obstructive Lung Disease (13 estimates). There was significant heterogeneity, which was incompletely explained by subgroup analysis (e.g. age and smoking status).The prevalence of physiologically defined chronic obstructive pulmonary disease in adults aged o40 yrs is ,9-10%. There are important regional gaps, and methodological differences hinder interpretation of the available data. The efforts of the Global Initiative for Chronic Obstructive Lung Disease and similar groups should help to standardise chronic obstructive pulmonary disease prevalence measurement.KEYWORDS: Chronic bronchitis, chronic obstructive pulmonary disease, emphysema, metaanalysis, prevalence, spirometry C hronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide [1]. In addition to generating high healthcare costs [2], COPD imposes a significant burden in terms of disability and impaired quality of life [3]. Unlike many leading causes of death and disability, COPD is projected to increase in much of the world as smoking frequencies rise and the population ages [4,5]. Despite the importance of this disease, the general perception is that the prevalence of COPD is not well measured. Accurate prevalence information is important for several reasons, including documentation of COPD's impact on disability, quality of life and costs, and for helping to inform public health planning [6]. It is also important to establish baseline prevalence rates so that researchers can monitor trends, including the success or failure of control efforts.Previous publications have reviewed the literature qualitatively, but not quantitatively [7,8].These reviews identified potential sources of interstudy variation that could affect reported prevalence estimates. Historically, COPD has been defined symptomatically as chronic bronchitis (CB), anatomically as emphysema, or, most recently, physiologically as airway obstruction [9]. The physiological definition has become the most common [10,11], although studies using other case definitions are still published. Even with growing consensus on the...

Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension.The present study analysed data from 20,296 subjects aged o45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). The sample was stratified based on baseline lung function data, according to modified Global Initiative for Obstructive Lung Disease (GOLD) criteria. Comorbid disease at baseline and death and hospitalisations over a 5-yr follow-up were then searched for.Lung function impairment was found to be associated with more comorbid disease. In logistic regression models adjusting for age, sex, race, smoking, body mass index and education, subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-1.9), hypertension (OR 1.6, 95% CI 1.3-1.9) and cardiovascular disease (OR 2.4, 95% CI 1.9-3.0). Comorbid disease was associated with a higher risk of hospitalisation and mortality that was worse in people with impaired lung function.Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations.

The incidence of sepsis is disproportionately increased in elderly adults, and age is an independent predictor of mortality. Compared with younger sepsis patients, elderly nonsurvivors of sepsis die earlier during hospitalization and elderly survivors more frequently require skilled nursing or rehabilitative care after hospitalization. These findings have implications for patient care and health care resource prioritization and provide insights for expanded scientific investigations and potential patient interventions.

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