Comparing the Performance of Two Screening Questionnaires for Chronic Obstructive Pulmonary Disease in the Chinese General Population

Abstract

Purpose

Screening questionnaires can help identify individuals at a high risk of COPD. This study aimed to compare the performance of the COPD population screener (COPD-PS) and COPD screening questionnaire (COPD-SQ) on the general population as a full cohort and stratified by urbanization.

Methods

We recruited subjects who underwent a health checkup at urban and rural community health centers in Beijing. All eligible subjects completed the COPD-PS and COPD-SQ, then spirometry. Spirometry-defined COPD was defined as a post-bronchodilator FEV₁/FVC<70%. Symptomatic COPD was defined as a post-bronchodilator FEV₁/FVC<70% and respiratory symptoms. Receiver operating characteristic (ROC) curve analysis compared the discriminatory power of the two questionnaires, and stratified by urbanization.

Results

We identified 129 spirometry-defined and 92 symptomatic COPD cases out of 1350 enrolled subjects. The optimal cut-off score for the COPD-PS was 4 for spirometry-defined and 5 for symptomatic COPD. The optimum cut-off score for the COPD-SQ was 15 for both spirometry-defined and symptomatic COPD. The COPD-PS and COPD-SQ had similar AUC values for spirometry-defined (0.672 vs 0.702) and symptomatic COPD (0.734 vs 0.779). The AUC of the COPD-SQ tended to be higher in rural areas than that of the COPD-PS for spirometry-defined COPD (0.700 vs 0.653, P = 0.093).

Conclusion

The COPD-PS and COPD-SQ had comparable discriminatory power for detecting COPD in the general population while the COPD-SQ performed better in rural areas. A pilot study for validating and comparing the diagnostic accuracy of different questionnaires is required when screening for COPD in a new environment.

Keywords:

• chronic obstructive pulmonary disease
• screening
• general population
• urbanization
• COPD-SQ
• COPD-PS

Abbreviations

AUC, area under the curve; BD, bronchodilator; BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; COPD-PS, COPD population screener; COPD-SQ, COPD screening questionnaire; DALYs, disability-adjusted life-years; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, global initiative for chronic obstructive lung disease; IQR, interquartile range; LMICs, low- and middle-income countries; +LR, positive likelihood ratio; -LR, negative likelihood ratio; NPV, negative predictive value; PPV, positive predictive value; ROC, receiver operating characteristic; SD, standard deviation; SDI, socio-demographic index; YI, Youden index.

Data Sharing Statement

The datasets generated and analyzed during the current study are not publicly available because other studies involving this data are in progress. However, data is available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

The study design was approved by the Ethics Committee of Beijing Chao-Yang Hospital (no. 2021-6-22-2) in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients.

Consent for Publication

This article has not been published elsewhere in whole or in part. All authors have read and approved the content, and agree to submit it for consideration for publication in your journal.

Acknowledgments

We would like to acknowledge the Liyuan Community Health Service Center, Tongzhou District, Beijing; Gaobeidian Community Health Service Center, Chaoyang District, Beijing; and Xinchengzi Community Health Service Center, Miyun District, Beijing, for their assistance in enrolling the subjects.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors declare that they have no competing interests.

Additional information

Funding

This study was supported by the Financial Budgeting Project of Beijing Institute of Respiratory Medicine (Ysbz2023001) and the “Summit” talent training program, Beijing Hospital Authority (DFL20190301), but had no role in the writing or submission of this manuscript.