How Reliable Are Current Data for Assessing the Actual Prevalence of Chronic Obstructive Pulmonary Disease?

• Published in: PloS one Vol. 11; no. 2; p. e0149302
• Main Authors: Romanelli, Anna Maria, Raciti, Mauro, Protti, Maria Angela, Prediletto, Renato, Fornai, Edo, Faustini, Annunziata
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.02.2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Charts; Chronic illnesses; Chronic obstructive pulmonary disease; Computer and Information Sciences; Epidemiology; Estimates; Estimation; Female; Health risk assessment; Heart failure; Hospitals; Humans; Italy - epidemiology; Lung diseases; Male; Medicine and Health Sciences; Middle Aged; Mortality; Obstructive lung disease; People and Places; Physiology; Prevalence; Primary care; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Registries; Research and Analysis Methods; Retrospective Studies; Sensitivity; Studies; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0149302

Estimating COPD occurrence is perceived by the scientific community as a matter of increasing interest because of the worldwide diffusion of the disease. We aimed to estimate COPD prevalence by using administrative databases from a city in central Italy for 2002-2006, improving both the sensitivity and the reliability of the estimate. Multiple sources were used, integrating the hospital discharge register (HDR), clinical charts, spirometry and the cause-specific mortality register (CMR) in a longitudinal algorithm, to reduce underestimation of COPD prevalence. Prevalence was also estimated on the basis of COPD cases confirmed through spirometry, to correct misclassification. Estimating such prevalence relied on using coefficients of validation, derived as the positive predictive value (PPV) for being an actual COPD case from clinical and spirometric data at the Institute of Clinical Physiology of the National Research Council. We found that sensitivity of COPD prevalence increased by 37%. The highest estimate (4.43 per 100 residents) was observed in the 5-year period, using a 3-year longitudinal approach and combined data from three sources. We found that 17% of COPD cases were misclassified. The above estimate of COPD prevalence decreased (3.66 per 100 residents) when coefficients of validation were applied. The PPV was 80% for the HDR, 82% for clinical diagnoses and 91% for the CMR. Adjusting the COPD prevalence for both underestimation and misclassification of the cases makes administrative data more reliable for epidemiological purposes.