Abstract
BackgroundCOPD-diagnosis is confirmed by post-bronchodilator (BD) spirometry. However, epidemiological studies often rely on pre-BD spirometry, self-reports, or medical records. This population-based study aims to determine COPD-prevalence based on four different operational definitions and their level of agreement, and to compare associations between COPD-definitions and risk factors.MethodsCOPD-prevalence in 1,793 adults from the general Dutch population (aged 18–70 years) was assessed based on self-reported data, Electronic Medical Records (EMR), and post-BD spirometry: using the FEV1/FVC below the lower limit of normal (LLN) and GOLD fixed cut-off (FEV1/FVC <0.70). Using spirometry as a reference, sensitivity was calculated for self-reported and EMR-based COPD. Associations between COPD and known risk factors were assessed with logistic regression. Data were collected as part of the cross-sectional VGO study (Livestock Farming and Neighboring Residents’ Health Study).ResultsThe highest prevalence was found based on spirometry (GOLD: 10.9%, LLN: 5.9%), followed by self-report (4.6%) and EMR (2.9%). Self-reported or EMR-based COPD identified less than 30% of all COPD-cases based on spirometry. The direction of association between known risk factors and COPD was similar across the four definitions, however, magnitude and significance varied. Especially indicators of allergy were more strongly associated with self-reported COPD compared to the other definitions.ConclusionsCOPD-prevalence varied depending on the used definition. A substantial number of subjects with spirometry-based COPD cannot be identified with questionnaires or medical records which can cause underestimation of COPD-prevalence. The influence of the different COPD-definitions on associations with known risk factors was limited.
Highlights
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide and expected to increase in the coming decades [1]
The highest prevalence was found based on spirometry (GOLD: 10.9%, lower limit of normal (LLN): 5.9%), followed by self-report (4.6%) and Electronic Medical Records (EMR) (2.9%)
Self-reported or EMR-based COPD identified less than 30% of all COPD-cases based on spirometry
Summary
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide and expected to increase in the coming decades [1]. Objective definitions based on spirometry tended to produce higher prevalence estimates than patient reported diagnosis and physician diagnosis (9.2% versus 4.9% versus 5.2%, respectively). This likely reflects the underestimation and under-diagnosis of the disease prevalence [3]. COPD based on post-bronchodilator (BD) spirometry is preferred in epidemiological studies and very common. Epidemiological studies often rely on pre-BD spirometry, self-reports, or medical records. This population-based study aims to determine COPD-prevalence based on four different operational definitions and their level of agreement, and to compare associations between COPD-definitions and risk factors
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