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In China, the burden of chronic obstructive disease (COPD) is high in never-smokers but little is known about its causes in this group. We analysed data on 287 000 female and 30 000 male never-smokers aged 30-79 years from 10 regions in China, who participated in the China Kadoorie Biobank baseline survey (2004-2008). Prevalence of airflow obstruction (AFO) (pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 and below the lower limit of normal (LLN)) was estimated, by age and region. Cross-sectional associations of AFO (FEV1/FVC <0.7), adjusted for confounding, were examined. AFO prevalence defined as FEV1/FVC <0.7 was 4.0% in females and 5.1% in males (mean ages 51 and 54 years, respectively). AFO prevalence defined as FEV1/FVC <LLN was 5.9% and 5.2%, respectively. In females, odds ratios of AFO were positively associated with lower household income (1.63, 95% CI 1.55-1.72 for lowest versus highest income groups), prior tuberculosis (2.36, 95% CI 2.06-2.71), less education (1.17, 95% CI 1.12-1.23 for no schooling versus college education), rural region and lower body mass index. AFO was positively associated with cooking with coal but not with other sources of household air pollution. Associations were similar for males. AFO is prevalent in Chinese never-smokers, particularly among those with low socioeconomic status or prior tuberculosis, and in rural males.

Original publication




Journal article


Eur Respir J

Publication Date





66 - 77


Adult, Aged, Air Pollution, Indoor, Asthma, Body Mass Index, China, Cooking, Cross-Sectional Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Odds Ratio, Prevalence, Pulmonary Disease, Chronic Obstructive, Respiration, Smoking, Spirometry, Surveys and Questionnaires, Vital Capacity