Journal article
Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease
Epidemiology (Cambridge, Mass.), Vol.31(3), pp.459-466
05/2020
DOI: 10.1097/EDE.0000000000001176
PMCID: PMC7138734
PMID: 32028323
Abstract
Various questionnaire-based definitions of chronic obstructive pulmonary disease (COPD) have been applied using the US representative National Health and Nutrition Examination Survey (NHANES), but few have been validated against objective lung function data. We validated two prior definitions that incorporated self-reported physician diagnosis, respiratory symptoms, and/or smoking. We also validated a new definition that we developed empirically using gradient boosting, an ensemble machine learning method.
Data came from 7,996 individuals 40-79 years who participated in NHANES 2007-2012 and underwent spirometry. We considered participants "true" COPD cases if their ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity was below 0.7 or the lower limit of normal. We stratified all analyses by smoking history. We developed a gradient boosting model for smokers only; predictors assessed (25 total) included sociodemographics, inhalant exposures, clinical variables, and respiratory symptoms.
The spirometry-based COPD prevalence was 26% for smokers and 8% for never smokers. Among smokers, using questionnaire-based definitions resulted in a COPD prevalence ranging from 11% to 16%, sensitivity ranging from 18% to 35%, and specificity ranging from 88% to 92%. The new definition classified participants based on age, bronchodilator use, body mass index (BMI), smoking pack-years, and occupational organic dust exposure, and resulted in the highest sensitivity (35%) and specificity (92%) among smokers. Among never smokers, the COPD prevalence ranged from 4% to 5%, and we attained good specificity (96%) at the expense of sensitivity (9-10%).
Our results can be used to parametrize misclassification assumptions for quantitative bias analysis when pulmonary function data are unavailable.
Details
- Title: Subtitle
- Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease
- Creators
- Lydia Feinstein - Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NCJesse Wilkerson - From the Social & Scientific Systems, Durham, NCPaivi M Salo - Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NCNathaniel MacNell - From the Social & Scientific Systems, Durham, NCMatthew F Bridge - From the Social & Scientific Systems, Durham, NCMichael B Fessler - Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NCPeter S Thorne - Department of Occupational and Environmental Health, University of Iowa, Iowa City, IowaAngelico Mendy - Department of Occupational and Environmental Health, University of Iowa, Iowa City, IowaRichard D Cohn - Independent consultant, Chapel Hill, NCMatthew D Curry - From the Social & Scientific Systems, Durham, NCDarryl C Zeldin - Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
- Resource Type
- Journal article
- Publication Details
- Epidemiology (Cambridge, Mass.), Vol.31(3), pp.459-466
- DOI
- 10.1097/EDE.0000000000001176
- PMID
- 32028323
- PMCID
- PMC7138734
- NLM abbreviation
- Epidemiology
- ISSN
- 1044-3983
- eISSN
- 1531-5487
- Publisher
- United States
- Grant note
- Z01 ES025041 / Intramural NIH HHS HHSN273201600002C / NIEHS NIH HHS
- Language
- English
- Date published
- 05/2020
- Academic Unit
- Civil and Environmental Engineering; Occupational and Environmental Health
- Record Identifier
- 9984001085002771
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