COPD is the third leading cause of mortality worldwide (1) and widely underdiagnosed.(2) A number of methods have been proposed for identifying individuals with undiagnosed disease early to prevent further disease progression. However this requires additional healthcare resources and more efficient approaches are needed. One approach is to use risk prediction models that use data held in electronic health records to stratify patients according to their risk of undiagnosed COPD.
We used case control data from a large primary care dataset, the Clinical Practice Research Datalink (CPRD), to develop and validate a risk prediction model and clinical score for undiagnosed COPD. This required application of skills learnt on the MPH including health information and informatics, epidemiology, and statistics.
The study included 15,159 patients with newly diagnosed COPD and 28,296 age and sex-matched controls without COPD, and found a number of routinely recorded risk factors that were predictive of COPD. These included smoking status, history of asthma, prescriptions of salbutamol and antibiotics for lower respiratory tract infections. The model was tested on a separate patient sample and showed high accuracy for discriminating between patients with and without COPD.
The study was presented at the European Respiratory Society in 2013 and was published in BMJ Open Respiratory Research.(3) The model could potentially be integrated with clinical information systems to help primary care clinicians target patients who might benefit from case finding strategies for COPD.
By Shamil Haroon, Public Health Specialty Registrar and Honorary Clinical Research Fellow
References:
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128.
2. Soriano J, Zielinski J, Price D. Screening for and early detection of chronic obstructive pulmonary disease. Lancet. 2009;374(9691):721 – 32.
3. Haroon S, Adab P, Riley RD, Marshall T, Lancashire R, Jordan RE. Predicting risk of COPD in primary care: development and validation of a clinical risk score. BMJ Open Respiratory Research. 2015;2(1).
