COPD in England: a comparison of expected, model-based prevalence and observed prevalence from general practice data
Open Access
- 3 June 2010
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Public Health
- Vol. 33 (1), 108-116
- https://doi.org/10.1093/pubmed/fdq031
Abstract
BackgroundPrimary care data show that 765 000 people in England have a general practice (GP) diagnosis of chronic obstructive pulmonary disease (COPD). We hypothesized that this underestimates actual prevalence, and compared expected prevalence of COPD for English local authority areas with prevalence of diagnosed COPD.MethodsCross-sectional comparison of GP observed and model-based prevalence estimates (using spirometry data without clinical diagnosis) from the Health Survey for England. Local underdiagnosis of COPD was estimated as the ratio of observed to expected cases. We investigated geographical patterns using classical and geographically weighted regression analysis.ResultsBoth observed and expected prevalence of COPD varied widely between areas. There was evidence of a ‘north–south’ divide, with both observed and modelled prevalence higher in the north. The ratio of diagnosed to expected prevalence varied from 0.20 to 0.95, with a mean of 0.52. Underdiagnosis was more pronounced in urban areas, and is particularly severe in London. The inclusion of GP numbers in the analysis yielded a stronger regression relationship, suggesting primary care supply affects diagnosis.ConclusionBoth observed and modelled COPD prevalence varies considerably across England. Cost-effective case-finding strategies should be evaluated, especially in areas where the ratio of observed to expected cases is low.Keywords
This publication has 22 references indexed in Scilit:
- Smoking and Weight Change After New Health Diagnoses in Older AdultsJAMA Internal Medicine, 2009
- Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trialBMJ, 2008
- Model for estimating the population prevalence of chronic obstructive pulmonary disease: cross sectional data from the Health Survey for EnglandPopulation Health Metrics, 2007
- Smokers with airway obstruction are more likely to quit smokingThorax, 2006
- Definition, epidemiology, and risk factorsBMJ, 2006
- Global and regional burden of disease and risk factors, 2001: systematic analysis of population health dataThe Lancet, 2006
- Chronic obstructive pulmonary disease: current burden and future projectionsEuropean Respiratory Journal, 2006
- Prediction equations for normal and low lung function from the Health Survey for EnglandEuropean Respiratory Journal, 2004
- Diagnosis of Airflow Limitation Combined With Smoking Cessation Advice Increases Stop-Smoking RateSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2003
- Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population studyThorax, 2002