Chest
Original Research: COPDHealth Services Burden of Undiagnosed and Overdiagnosed COPD
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.