Abstract
BackgroundAirflow limitation is a critical physiological feature in chronic obstructive pulmonary disease (COPD), for which long-term exposure to noxious substances, including tobacco smoke, is an established risk. However, not all long-term smokers develop COPD, meaning that other risk factors exist.ObjectiveThis study aimed to predict the risk factors for COPD diagnosis using machine learning in an annual medical check-up database.MethodsIn this retrospective observational cohort study (ARTDECO [Analysis of Risk Factors to Detect COPD]), annual medical check-up records for all Hitachi Ltd employees in Japan collected from April 1998 to March 2019 were analyzed. Employees who provided informed consent via an opt-out model were screened and those aged 30 to 75 years without a prior diagnosis of COPD/asthma or a history of cancer were included. The database included clinical measurements (eg, pulmonary function tests) and questionnaire responses. To predict the risk factors for COPD diagnosis within a 3-year period, the Gradient Boosting Decision Tree machine learning (XGBoost) method was applied as a primary approach, with logistic regression as a secondary method. A diagnosis of COPD was made when the ratio of the prebronchodilator forced expiratory volume in 1 second (FEV1) to prebronchodilator forced vital capacity (FVC) was <0.7 during two consecutive examinations.ResultsOf the 26,101 individuals screened, 1213 met the exclusion criteria, and thus, 24,815 individuals were included in the analysis. The top 10 predictors for COPD diagnosis were FEV1/FVC, smoking status, allergic symptoms, cough, pack years, hemoglobin A1c, serum albumin, mean corpuscular volume, percent predicted vital capacity, and percent predicted value of FEV1. The areas under the receiver operating characteristic curves of the XGBoost model and the logistic regression model were 0.956 and 0.943, respectively.ConclusionsUsing a machine learning model in this longitudinal database, we identified a number of parameters as risk factors other than smoking exposure or lung function to support general practitioners and occupational health physicians to predict the development of COPD. Further research to confirm our results is warranted, as our analysis involved a database used only in Japan.
Highlights
Using a machine learning model in this longitudinal database, we identified a number of parameters as risk factors other than smoking exposure or lung function to support general practitioners and occupational health physicians to predict the development of chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation associated with persistent respiratory symptoms
The ARCTIC observational cohort study showed that late COPD diagnosis was associated with a higher exacerbation rate and increased comorbidities and costs compared with early diagnosis [7]
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation associated with persistent respiratory symptoms. Most patients with COPD experience exacerbation of symptoms and are at high risk of developing comorbidities such as cardiovascular disease [1]. Long-term exposure to tobacco smoke, vapor, gas, dust, and fumes is an established major risk factor for COPD [2]. Only a small percentage of smokers develop airflow limitation, while nonsmokers can develop COPD [3] These inconsistencies indicate that risk factors other than long-term smoking are associated with COPD [4]. Airflow limitation is a critical physiological feature in chronic obstructive pulmonary disease (COPD), for which long-term exposure to noxious substances, including tobacco smoke, is an established risk. Not all long-term smokers develop COPD, meaning that other risk factors exist
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