Validation of general practitioner-diagnosed COPD in the UK General Practice Research Database
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Background: Information in large, automated databases can be useful to study the natural history of respiratory diseases in the community, but the validity of definitions needs to be demonstrated. Aim: To compare a simple computer algorithm that identifies patients diagnosed with chronic obstructive pulmonary disease (COPD) and severity of COPD in the UK General Practice Research Database (GPRD) with general practitioner (GP) clinical records, to evaluate the utility of this algorithm for identifying COPD patients and for distinguishing COPD from asthma. Methods: Using a computer algorithm identifying patients by diagnostic codes and allotting three grades of severity by drug use, a sample of 225 patients in the GPRD with a diagnosis of COPD and an age–sex matched group of 75 patients with asthma were randomly selected. Questionnaires were posted to the GPs of the 300 selected patients who were asked to state diagnosis and to grade severity based on the individual's medical record. Agreement was quantified with the κ index, an estimator that accounts for agreement that occurs by chance. Results: Response rate was 85.7%. The concordance between COPD diagnosis by the GPRD algorithm with that of the GP was quantified as a κ of 0.52, and the concordance between COPD severity by the GPRD algorithm with that of the GP was quantified as a κ of 0.54. The κ index for COPD diagnosis increased with increasing severity of COPD (0.46, 0.59, and 0.68 for mild, moderate and severe COPD, respectively), but similar good agreement was observed in a stratified analysis by sex, age, smoking status and number of comorbidities. Conclusions: It is concluded that the GPRD algorithms used for diagnosis and severity of COPD are a good screening tool for COPD in the UK general population, and satisfactorily differentiate COPD from asthma patients, particularly when disease is moderate or severe.
- The World Health Report 1998. Life in the 21st Century. A Vision for all. Geneva: World Health Organization, 1998.
- Rawson NS, Malcolm E. Validity of the recording of ischaemic heart disease and chronic obstructive pulmonary disease in the Saskatchewan health care data-files. Stat Med 1995; 14: 2627–2643.
- Soriano JB, Maier WC, Egger P, etal. Recent trends of physician-diagnosed COPD in women and men in the UK. Thorax 2000; 55: 789–794.
- Garcia Rodriguez LA, Perez-Gutthann S. Use of theUK General Practice Research Database for pharmacoepidemiology. Br J Clin Pharmacol 1998; 45: 419–425.
- Nazareth I, King M, Haines A, Rangel L, Myers S. Accuracy of diagnosis on general practice computer system. Br Med J 1993; 307: 32–34.
- Traver GA, Cline MG, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease. Am Rev Respir Dis 1979; 119: 895–902.
- Fabbri L, Caramori G, Beghe B, Papi A, Ciaccia A. Chronic obstructive pulmonary disease international guidelines. Curr Opin Pulm Med 1998; 4: 76–84.
- Everitt BS. Statistical Methods for Medical Investigations. New York: Halsted Press, 1994.
- Chronic Obstructive Pulmonary Disease: The Key Facts. British Lung Foundation, 1997.
- Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed., New York: John Wiley and sons, 1981: 212–236.
- Armitage P, Berry G. Statistical Methods in Medical Research. 3rd ed., Oxford: Blackwell Scientific Publications, 1994.
- Jick H, Jick SS, Derby LE. Validation of information recorded on general practitioner based computerised data resource in the United Kingdom. Br Med J 1991; 302: 766–768.
- Jick H, Terris BZ, Derby LE, Jick SS. Further validation of information recorded on a general practitioner based computerised data resource in the United Kingdom. Pharmacoepidemiol Drug Safety 1992; 1: 347–349.
- Schellevis FG, van de Lisdonk E, van der Velden J, van Eijk JT, van Weel C. Validity of diagnoses of chronic diseases in general practice. The application of diagnostic criteria. J Clin Epidemiol 1993; 46: 461–468.
- Hansell A, Hollowell J, Nichols T, McNiece R, Strachan D. Use of the General Practice Research Database (GPRD) for respiratory epidemiology: A comparison with the 4th Morbidity Survey in General Practice (MSGP4). Thorax 1999; 54: 413–419.
- Martinez F, Sunyer J, Anto JM. Reliability of a monitoring system for respiratory emergency room admissions. Eur Respir J 1993; 6: 337–341.
- Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: Data from the National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 2000; 160: 1683–1689.
- Dow L. Asthma versus chronic obstructive pulmonary disease – exploring why ‘reversibility versus irreversibility’ is no longer an appropriate approach. Clin Exp Allergy 1999; 29: 739–743.
- Jones K. Diagnosing airflow obstruction in general practice. Thorax 1999; 54: 1051–1052.
- Grifiths C, Feder G, Wedzicha J, Foster G, Livingstone A, Marlowe GS. Feasibility of spirometry and reversibility testing for the identification of patients with chronic obstructive pulmonary disease on asthma registers in general practice. Respir Med 1999; 93: 903–908.
- Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHOGlobal Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir CritCare Med 2001; 163: 1256–1276.
- O'Brien C, Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax 2000; 55: 635–642.
- Soriano JB, Maier WC, Egger P, Visick G, Sykes J, Pride NB. Validation of Physician-Diagnosed COPD in the UK General Practice Research Database. Am J Respir Crit Care Med 2000 (abstract); 161: A820.
- Validation of general practitioner-diagnosed COPD in the UK General Practice Research Database
European Journal of Epidemiology
Volume 17, Issue 12 , pp 1075-1080
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers
- Additional Links
- Automated database
- κ index
- Industry Sectors
- Author Affiliations
- 1. Worldwide Epidemiology, GlaxoSmithKline Research and Development, Greenford, Middlesex, London, UK
- 2. Health Promotion Research Unit, London School of Hygiene and Tropical Medicine, London, UK