Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema

<p>Abstract</p> <p>Background</p> <p>Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB) and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices.</p> <p>Methods</p> <p>Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics.</p> <p>Results</p> <p>Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28), current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41) and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94). For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited data show risk decreases with increasing starting age for COPD and CB and with increasing quitting duration for COPD. No clear relationship is seen with duration of smoking.</p> <p>Conclusions</p> <p>The results confirm and quantify the causal relationships with smoking.</p

Using high-resolution LiDAR data to quantify the three-dimensional structure of vegetation in urban green space

The spatial arrangement and vertical structure of vegetation in urban green spaces are key factors in determining the types of benefits that urban parks provide to people. This includes opportunities for recreation, spiritual fulfilment and biodiversity conservation. However, there has been little consideration of how the fine-scale spatial and vertical structure of vegetation is distributed in urban parks, primarily due to limitations in methods for doing so. We addressed this gap by developing a method using Light Detection and Ranging (LiDAR) data to map, at a fine resolution, tree cover, vegetation spatial arrangement, and vegetation vertical structure. We then applied this method to urban parks in Brisbane, Australia. We found that parks varied mainly in their amount of tree cover and its spatial arrangement, but also in vegetation vertical structure. Interestingly, the vertical structure of vegetation was largely independent of its cover and spatial arrangement. This suggests that vertical structure may be being managed independently to tree cover to provide different benefits across urban parks with different levels of tree cover. Finally, we were able to classify parks into three distinct classes that explicitly account for both the spatial and vertical structure of tree cover. Our approach for mapping the three-dimensional vegetation structure of urban green space provides a much more nuanced and functional description of urban parks than has previously been possible. Future research is now needed to quantify the relationships between vegetation structure and the actual benefits people derive from urban green space.</p