Smoking is the most well-established cause of chronic
airflow obstruction (CAO) but particulate air pollution
and poverty have also been implicated. We regressed
sex-specific prevalence of CAO from 41 Burden of
Obstructive Lung Disease study sites against smoking
prevalence from the same study, the gross national
income per capita and the local annual mean level
of ambient particulate matter (PM2.5) using negative
binomial regression. The prevalence of CAO was not
independently associated with PM2.5 but was strongly
associated with smoking and was also associated with
poverty. Strengthening tobacco control and improved
understanding of the link between CAO and poverty
should be prioritised.

Andre F S Amaral, Peter G J Burney , Jaymini Patel , Cosetta Minelli , Filip Mejza , David M Mannino , Terence A R Seemungal , Padukudru Anand Mahesh , Li Cher Lo , Christer Janson , Sanjay Juvekar , Meriam Denguezli , Imed Harrabi , Emiel F M Wouters , Hamid Cherkaski , Kevin Mortimer , Rain Jogi , Eric D Bateman , Elaine Fuertes , Mohammed Al Ghobain , Wan Tan , Daniel O Obaseki , Asma El Sony , Michael Studnicka , Althea Aquart-Stewart , Parvaiz Koul , Herve Lawin , Asaad Ahmed Nafees , Olayemi Awopeju , Gregory E Erhabor , Thorarinn Gislason , Tobias Welte , Amund Gulsvik , Rune Nielsen , Louisa Gnatiuc , Ali Kocabas , Guy B Marks , Talant Sooronbaev , Bertrand Hugo Mbatchou Ngahane , Cristina Barbara , A Sonia Buist , and The BOLD (Burden of Obstructive Lung Disease) Collaborative Research Group. "Chronic airflow obstruction and ambient particulate air pollution." BMJ (2021).