Journal article
Use of the Spirometric "Fixed-Ratio" Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study
Journal of general internal medicine : JGIM, Vol.38(13), pp.2988-2997
10/2023
DOI: 10.1007/s11606-023-08185-5
PMCID: PMC10593702
PMID: 37072532
Abstract
Background
COPD diagnosis is tightly linked to the fixed-ratio spirometry criteria of FEV1/FVC < 0.7. African-Americans are less often diagnosed with COPD.
Objective
Compare COPD diagnosis by fixed-ratio with findings and outcomes by race.
Design
Genetic Epidemiology of COPD (COPDGene) (2007–present), cross-sectional comparing non-Hispanic white (NHW) and African-American (AA) participants for COPD diagnosis, manifestations, and outcomes.
Setting
Multicenter, longitudinal US cohort study.
Participants
Current or former smokers with ≥ 10-pack-year smoking history enrolled at 21 clinical centers including over-sampling of participants with known COPD and AA. Exclusions were pre-existing non-COPD lung disease, except for a history of asthma.
Measurements
Subject diagnosis by conventional criteria. Mortality, imaging, respiratory symptoms, function, and socioeconomic characteristics, including area deprivation index (ADI). Matched analysis (age, sex, and smoking status) of AA vs. NHW within participants without diagnosed COPD (GOLD 0; FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7).
Results
Using the fixed ratio, 70% of AA (n = 3366) were classified as non-COPD, versus 49% of NHW (n = 6766). AA smokers were younger (55 vs. 62 years), more often current smoking (80% vs. 39%), with fewer pack-years but similar 12-year mortality. Density distribution plots for FEV1 and FVC raw spirometry values showed disproportionate reductions in FVC relative to FEV1 in AA that systematically led to higher ratios. The matched analysis demonstrated GOLD 0 AA had greater symptoms, worse DLCO, spirometry, BODE scores (1.03 vs 0.54, p < 0.0001), and greater deprivation than NHW.
Limitations
Lack of an alternative diagnostic metric for comparison.
Conclusions
The fixed-ratio spirometric criteria for COPD underdiagnosed potential COPD in AA participants when compared to broader diagnostic criteria. Disproportionate reductions in FVC relative to FEV1 leading to higher FEV1/FVC were identified in these participants and associated with deprivation. Broader diagnostic criteria for COPD are needed to identify the disease across all populations.
Details
- Title: Subtitle
- Use of the Spirometric "Fixed-Ratio" Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study
- Creators
- Elizabeth A Regan - National Jewish HealthMelissa E Lowe - Duke Medical CenterBarry J Make - National Jewish HealthJeffrey L Curtis - Michigan MedicineQuan Grace Chen - Edwards Lifesciences (United States)Michael H Cho - Brigham and Women's HospitalJames L Crooks - Colorado School of Public HealthKatherine E Lowe - Case Western Reserve UniversityCarla Wilson - National Jewish HealthJames K O'Brien - National Jewish HealthGabriela R Oates - University of Alabama at BirminghamArianne K Baldomero - University of MinnesotaGregory L Kinney - Colorado School of Public HealthKendra A Young - Colorado School of Public HealthAlejandro A Diaz - Harvard UniversitySurya P Bhatt - University of Alabama at BirminghamMeredith C McCormack - Johns Hopkins MedicineNadia N Hansel - Johns Hopkins MedicineVictor Kim - Temple UniversityNicole E Richmond - Colorado School of Public HealthGloria E Westney - Morehouse School of MedicineMarilyn G Foreman - Morehouse School of MedicineDouglas J Conrad - University of California San DiegoDawn L DeMeo - Brigham and Women's HospitalKarin F Hoth - University of IowaHannatu Amaza - University of IowaAparna Balasubramanian - Johns Hopkins MedicineJulia Kallet - National Jewish HealthShandi Watts - National Jewish HealthNicola A Hanania - Baylor College of MedicineJohn Hokanson - Colorado School of Public HealthTerri H Beaty - Johns Hopkins UniversityJames D Crapo - National Jewish HealthEdwin K Silverman - Brigham and Women's HospitalRichard Casaburi - Ronald Reagan UCLA Medical CenterRobert Wise - Johns Hopkins Medicine
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.38(13), pp.2988-2997
- DOI
- 10.1007/s11606-023-08185-5
- PMID
- 37072532
- PMCID
- PMC10593702
- NLM abbreviation
- J Gen Intern Med
- eISSN
- 1525-1497
- Grant note
- Lung / NHLBI NIH HHS U01 HL089897 / NHLBI NIH HHS Award Number U01 HL089856 from the National Heart / NHLBI NIH HHS Blood Institute / NHLBI NIH HHS
- Language
- English
- Electronic publication date
- 04/18/2023
- Date published
- 10/2023
- Academic Unit
- Psychiatry; Iowa Neuroscience Institute; Internal Medicine
- Record Identifier
- 9984398207402771
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