Article Figures & Data
Figures
- Figure 1. Study design. BMI = body mass index. COPD = chronic obstructive pulmonary disease. ICD-10 = International Classification of Diseases, Tenth Revision.
- Figure 2. Proportion of patients with evidence of chronic obsructive pulmonary disease (COPD) by diagnostic criteria. FEV/FVC = forced expiratory volume/forced vital capacity. LLN = lower limit of normal
- Figure 3. Proportion of patients with a missed COPD diagnosis by year of death (panel A shows definition A, panel B shows definition E). BLF = British Lung Foundation. COPD = chronic obstructive pulmonary disease. QOF = Quality and Outcomes Framework.
Tables
Group Definition A Specific COPD code only:Diagnostic COPD code or record of acute exacerbation of COPD in either primary care or secondary care data using previously validated Read or SNOMED-CT or International Classification of Diseases, Tenth Revision (ICD-10) codes11 (see Supplementary Tables S1 and S2 for additional codes used to identify COPD and COPD exacerbations using SNOMED-CT codes) B Specific COPD code and record of spirometry:Record of spirometry being performed at any time in a patient's medical history C Specific COPD code and medication prescribed within 4 weeks of a diagnostic code D Specific COPD code, presence of spirometry and medication prescribed within 4 weeks of a diagnostic code E Specific COPD code with post-bronchodilator spirometry confirmed obstruction(forced expiratory volume [FEV]1/forced vital capacity [FVC] <0.7) F Specific COPD code with post-bronchodilator spirometry confirmed obstructionFEV1/FVC < lower limit of normal (LLN) - Table 1. Characteristics of patients with missed COPD diagnosis compared with those with diagnosed COPD using the main definition (B: COPD code and presence of spirometry)
Missed COPD diagnosis COPD diagnosis P value n = 37 763 n = 40 858 Age at death 80 (73–87) 79 (72–85) <0.001 Sex Female 18 339 (48.6%) 18 907 (46.3%) <0.001 IMD 1 (least deprived) 5544 (14.7%) 5812 (14.2%) 0.085 2 6508 (17.2%) 7221 (17.7%) 3 7258 (19.2%) 7965 (19.5%) 4 8205 (21.7%) 9088 (22.2%) 5 (most deprived) 9986 (26.4%) 10 693 (26.2%) Missing 262 (0.7%) 79 (0.2%) Region South of England 20 154 (53.4%) 20 836 (51.0%) <0.001 North of England 17 609 (46.6%) 20 022 (49.0%) Ethnic group White 31 593 (83.7%) 37 949 (92.9%) <0.001 Asian 236 (0.6%) 223 (0.5%) Black 162 (0.4%) 121 (0.3%) Mixed or other 253 (0.7%) 200 (0.5%) Missing 5519 (14.6%) 2365 (5.8%) BMI (kg/m2) Underweight (<18.5) 3004 (8.0%) 6433 (15.7%) <0.001 Healthy weight (18.5–24.9) 11 697 (31.0%) 17 361 (42.5%) Overweight (25.0–39.9) 5727 (15.2%) 8274 (20.3%) Obese (>40) 3399 (9.0%) 5619 (13.8%) Missing 13 936 (36.9%) 3171 (7.8%) Comorbid conditions Heart failure 14 716 (39.0%) 17 001 (41.6%) <0.001 Asthma (ever) 15 645 (41.4%) 24 846 (60.8%) <0.001 Asthma (year before) 3177 (8.4%) 4318 (10.6%) <0.001 Bronchiectasis 2324 (6.2%) 4872 (11.9%) <0.001 Interstitial lung disease 1686 (4.5%) 2795 (6.8%) <0.001 Symptom burden Cough symptoms 13 453 (35.6%) 27 843 (68.1%) <0.001 Sputum production 6752 (17.9%) 18 886 (46.2%) <0.001 Breathlessness 27 351 (72.4%) 38 179 (93.4%) <0.001 Smoking status Currently smokes 13 201 (35.0%) 13 072 (32.0%) <0.001 Formerly smoked 9478 (25.1%) 23 366 (57.2%) Never smoked 5061 (13.4%) 3410 (8.3%) Missing smoking status 10 023 (26.5%) 1010 (2.5%) BMI = body mass index. COPD = chronic obstructive pulmonary disease. IMD = Index of Multiple Deprivation. Data are presented as n (%) for categorical measures, and median and interquartile range for numerical variables. Comorbidities assessed as occurring at any point in medical record before death.
- Table 2. Adjusted odds ratios for missed COPD diagnosis for all factors tested in the multiple regression model
Odds ratio (95% CI) P value Birth year 0.99 (0.99 to 1.00) <0.001 Female 1.16 (1.12 to 1.21) <0.001 Year of death 0.86 (0.86 to 0.87) <0.001 Smoking Status Formerly Smoked vs Currently Smokes 0.42 (0.40 to 0.43)* <0.001 No Smoking Record vs Currently Smokes 4.52 (4.13 to 4.95)* <0.001 Never smoked vs Currently smokes 1.26 (1.18 to 1.35)* <0.001 BMI (kg/m2) Underweight vs Healthy Weight 0.63 (0.59 to 0.67)* <0.001 Overweight vs Healthy Weight 1.15 (1.10 to 1.21)* <0.001 Obese vs Healthy Weight 1.11 (1.05 to 1.17)* <0.001 Region North of England vs South of England 0.86 (0.80 to 0.92)* <0.001 IMD Quintile 2 vs 1 (least deprived) 0.96 (0.90 to 1.03) 0.23 3 vs 1 0.96 (0.90 to 1.03) 0.255 4 vs 1 0.95 (0.88 to 1.02) 0.122 5 vs 1 1.02 (0.95 to 1.10) 0.63 Ethnic group Black vs White 1.87 (1.37 to 2.54)* <0.001 Mixed/Other vs White 1.08 (0.83 to 1.39) 0.654 Asian vs White 1.54 (1.21 to 1.96)* <0.001 Unknown vs White 1.28 (1.20 to 1.38)* <0.001 Comorbid conditions Asthma 0.39 (0.38 to 0.41)* <0.001 Interstitial lung disease 0.92 (0.85 to 1.00)* 0.04 Bronchiectasis 0.72 (0.68 to 0.77)* <0.001 IMD = Index of Multiple Deprivation. Northern regions include North East, North West, Yorkshire and the Humber, East Midlands, West Midlands.Southern regions include East of England, South West, South Central, London, South East Coast.
Statistically significant results are indicated in bold with asterisk.
Supplementary Data
- Gayle_BJGPO.2022.0060_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Are we missing lifetime COPD diagnosis among people with COPD recorded death? A population-based retrospective cohort study
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