Chest
Volume 153, Issue 6, June 2018, Pages 1336-1346
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Original Research: COPD
Health Services Burden of Undiagnosed and Overdiagnosed COPD

An earlier version of the information in this article was presented as an abstract (“Quantifying the burden of undiagnosed and overdiagnosed chronic obstructive pulmonary disease [COPD]”) at the 2013 American Thoracic Society International Conference, May 17-22, 2013, Philadelphia, PA.
https://doi.org/10.1016/j.chest.2018.01.038Get rights and content

Background

Misdiagnosis of COPD is common. The goal of this study was to quantify the health services burden of undiagnosed and overdiagnosed COPD in a real-world, North American population.

Methods

A population-based cohort study was conducted. Presence of COPD using spirometry was ascertained in randomly selected adults aged ≥ 40 years from Ontario, Canada, who participated in the Canadian Obstructive Lung Disease study. The presence of physician-diagnosed COPD was ascertained for the same subjects by using linked health administrative data. Participants were then categorized into four groups: correctly diagnosed, undiagnosed, overdiagnosed, and no COPD according to either criteria. Age- and sex-standardized rates of hospitalizations, ED visits, and ambulatory care visits in each group were determined and compared.

Results

Of 1,403 participants, 13.7% had undiagnosed COPD, 5.1% were overdiagnosed, and 3.7% had correctly diagnosed COPD. Subjects with overdiagnosed COPD had significantly higher rates of hospitalizations, ED visits, and ambulatory care visits, and subjects with moderate to severe undiagnosed COPD had higher rates of hospitalizations, than subjects in the non-COPD population.

Conclusions

Undiagnosed and overdiagnosed COPD contribute to significant health care burden. Given that misdiagnosed COPD was fivefold more common than correctly diagnosed COPD, these findings point to a substantial misdiagnosis-associated burden of disease that might be prevented, at least in part, with a correct diagnosis.

Section snippets

Study Design

A population-based, longitudinal cohort study using clinical and health administrative data was conducted. Ethics approval was obtained from the institutional review board at Sunnybrook Health Sciences Centre; this approval included a waiver of informed consent.

Data Sources

The Canadian Obstructive Lung Disease (COLD) study is a population-based trial that prospectively gathered health information, including spirometry before and after bronchodilator administration, on a random population-based sample of

Undiagnosed and Overdiagnosed COPD

There were 1,586 COLD participants from Ontario; 96 (6.1%) had missing spirometric measurements, and 87 (5.5%) had data that could not be linked to health administrative records. Unlinked participants were slightly more likely to be male (56.3%) but otherwise had similar ages, severity of COPD, and smoking history (data not shown). Of the 1,403 participants included for analysis, 192 (13.7%) had undiagnosed COPD, 72 (5.1%) had overdiagnosed COPD, and 52 (3.7%) had correctly diagnosed COPD (

Discussion

We examined a representative group of subjects from North America and found that subjects with overdiagnosed COPD had higher rates of health services use than the non-COPD population. We also found that subjects with moderate to severe undiagnosed COPD had a higher hospitalization rate than the non-COPD population. Particularly given that misdiagnosed COPD was fivefold more common than correctly diagnosed COPD, these findings point to a large burden of misdiagnosis-associated disease that might

Conclusions

Subjects with overdiagnosed and undiagnosed COPD have higher rates of health services use than the general population. Because there are fivefold more subjects with misdiagnosed COPD than correctly diagnosed COPD, their absolute burdens are similar. Future research should examine strategies to reduce COPD misdiagnosis.

Acknowledgments

Author contributions: A. S. G. serves as guarantor. A. S. G. and T. T. conceived and designed the study; A. S. G. acquired the health administrative data and S. A., K. C., J. B., and W. T. acquired the clinical data; D. T. conducted the statistical analysis; A. S. G. drafted the manuscript and obtained funding; and A. S. G. and D. T. were involved in administrative support. A. S. G. and D. T. had full access to all the data in the study and take responsibility for the integrity of the data and

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    FUNDING/SUPPORT: Funding for this project was made available through the Government of Ontario, Canada and the Canadian Institutes of Health Research, Ottawa, Canada. This study was also supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Funding partners were the Canadian Institutes of Health Research (CIHR) (CIHR/Rx&D Collaborative Research Program Operating Grants 93326), the Respiratory Health Network of the Fonds de la recherche du Québec, and industry partners AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline (GSK) Canada Ltd, Novartis, and Pfizer Canada Ltd. Support was also obtained from the Canadian Lung Association. A. S. G. was supported by a New Investigator Award funded by team grant OTG-88591 from the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes while working on this study; she was also supported by a Physicians’ Services Incorporated Foundation Fellowship in Translational Medicine. She is currently supported by a Canadian Institute of Heath Research New Investigator award. K. C. is supported by the GSK-CIHR Research Chair in Respiratory Health Care Delivery at the University Health Network (Toronto, ON, Canada). The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.

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