Validation of Questionnaire-based Case Definitions for Chronic Obstructive Pulmonary Disease

Epidemiology - Tập 31 Số 3 - Trang 459-466 - 2020
Lydia Feinstein1,2,3,4,5,6,7, Jesse Wilkerson1,3,4,5,6,7, Päivi M. Salo1,8,4,5,6,7, Nathaniel MacNell1,3,4,5,6,7, Matthew F. Bridge1,3,4,5,6,7, Michael B. Fessler1,8,4,5,6,7, Peter S. Thorne1,9,4,5,6,7, Angelico Mendy1,9,8,4,5,6,7, Richard D. Cohn1,10,3,4,5,6,7, Matthew D. Curry1,3,4,5,6,7, Darryl C. Zeldin1,8,4,5,6,7
1All data used in this analysis are publicly available and can be downloaded on the Centers for Disease Control web site: https://wwwn.cdc.gov/nchs/nhanes/Default.aspx. SAS code used in this analysis is provided in eAppendix 2
2Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
3Social & Scientific Systems, Durham, NC
4Submitted August 19, 2019
5Supplemental Digital Content (https://links.lww.com/EDE/B642).
6Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).
7accepted January 29, 2020.
8Division of Intramural Research, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
9Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
10Independent Consultant, Chapel Hill, NC

Tóm tắt

Background: 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. Methods: 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. Results: 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%). Conclusion: Our results can be used to parametrize misclassification assumptions for quantitative bias analysis when pulmonary function data are unavailable.

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Epidemiology

Tập 31 Số 3

459-466

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