Prevalence of COPD and smoking in Spain: an ecological study by autonomous communities, 2023

To analyze the reported prevalence of chronic obstructive pulmonary disease (COPD) and daily tobacco use in the adult population of Spain during 2023, considering differences by sex and autonomous community. As a secondary objective, the ecological association between both indicators was explored at the regional level, without assuming individual-level causal relationships.

A cross-sectional ecological analytical study was conducted using aggregated data at the autonomous community level. The reported prevalence of COPD was obtained from the Primary Care Clinical Database, while the prevalence of smoking was obtained from the Spanish National Health Survey and the European Health Survey. Seventeen autonomous communities were analyzed, stratified by sex. Means, ranges, and standard deviations were calculated, and the relationship between both indicators was evaluated using correlational analyses (Pearson and Spearman) and simple linear regression models.

The reported prevalence of COPD was 3.56% at the national level, with a higher prevalence in men (4.75%) than in women (2.47%). The prevalence of daily tobacco use was 16.64%, with a male predominance (20.22%). A positive relationship was observed between smoking and recorded COPD, more pronounced in men (r = 0.52; P = 0.03) than in women (r = 0.33; P = 0.17).

Although the prevalence of smoking has decreased, territorial and gender inequalities persist in the distribution of COPD and smoking. It is recommended to strengthen tobacco prevention programs, improve early detection of COPD, and consider regional differences to guide evidence-based health policies.