Use of the Spirometric "Fixed-Ratio" Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Regan Elizabeth A, Lowe Melissa E, Make Barry J, Curtis Jeffrey L, Chen Quan Grace, Cho Michael H, Crooks James L, Lowe Katherine E, Wilson Carla, O'Brien James K, Oates Gabriela R, Baldomero Arianne K, Kinney Gregory L, Young Kendra A, Diaz Alejandro A, Bhatt Surya P, McCormack Meredith C, Hansel Nadia N, Kim Victor, Richmond Nicole E, Westney Gloria E, Foreman Marilyn G, Conrad Douglas J, DeMeo Dawn L, Hoth Karin F, Amaza Hannatu, Balasubramanian Aparna, Kallet Julia, Watts Shandi, Hanania Nicola A, Hokanson John, Beaty Terri H, Crapo James D, Silverman Edwin K, Casaburi Richard, Wise Robert
Аннотация
OBJECTIVE: Compare COPD diagnosis by fixed-ratio with findings and outcomes by race.
DESIGN: Genetic Epidemiology of COPD (COPDGene) (2007-present), cross-sectional comparing non-Hispanic white (NHW) and African-American (AA) participants for COPD diagnosis, manifestations, and outcomes.
SETTING: Multicenter, longitudinal US cohort study.
PARTICIPANTS: Current or former smokers with ≥ 10-pack-year smoking history enrolled at 21 clinical centers including over-sampling of participants with known COPD and AA. Exclusions were pre-existing non-COPD lung disease, except for a history of asthma.
MEASUREMENTS: Subject diagnosis by conventional criteria. Mortality, imaging, respiratory symptoms, function, and socioeconomic characteristics, including area deprivation index (ADI). Matched analysis (age, sex, and smoking status) of AA vs. NHW within participants without diagnosed COPD (GOLD 0; FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7).
RESULTS: Using the fixed ratio, 70% of AA (n = 3366) were classified as non-COPD, versus 49% of NHW (n = 6766). AA smokers were younger (55 vs. 62 years), more often current smoking (80% vs. 39%), with fewer pack-years but similar 12-year mortality. Density distribution plots for FEV1 and FVC raw spirometry values showed disproportionate reductions in FVC relative to FEV1 in AA that systematically led to higher ratios. The matched analysis demonstrated GOLD 0 AA had greater symptoms, worse DLCO, spirometry, BODE scores (1.03 vs 0.54, p < 0.0001), and greater deprivation than NHW.
LIMITATIONS: Lack of an alternative diagnostic metric for comparison.
CONCLUSIONS: The fixed-ratio spirometric criteria for COPD underdiagnosed potential COPD in AA participants when compared to broader diagnostic criteria. Disproportionate reductions in FVC relative to FEV1 leading to higher FEV1/FVC were identified in these participants and associated with deprivation. Broader diagnostic criteria for COPD are needed to identify the disease across all populations.