Development and Validation of a Screening Questionnaire of COPD from a Large Epidemiological Study in China

Abstract

Objective

We aimed to establish an easy-to-use screening questionnaire with risk factors and suspected symptoms of COPD for primary health care settings.

Methods

Based on a nationwide epidemiological study of pulmonary health among adults in mainland China (China Pulmonary Health, CPH study) between 2012 and 2015, participants ≥40 years who completed the questionnaire and spirometry tests were recruited and randomly divided into development set and validation set by the ratio of 2:1. Parameters including sex, age, BMI, residence, education, smoking status, smoking pack-years, biomass exposure, parental history of respiratory diseases and daily respiratory symptoms were initially selected for the development of scoring system. Receiver operating characteristic (ROC) curve, area under curve (AUC), positive and negative predictive values were calculated in development set and validation set.

Results

After random split by 2:1 ratio, 22443 individuals were assigned to development set and 11221 to validation set. Ten variables were significantly associated with COPD independently in development set after a stepwise selection by multivariable logistic model and used to develop scoring system. The scoring system yielded good discrimination, as measured by AUC of 0.7737, and in the validation set, the AUC was 0.7711. When applying a cutoff point of ≥16, the sensitivity in development set was 0.69 (0.67 − 0.71); specificity 0.72 (0.71 − 0.73), PPV 0.25 (0.24 − 0.26) and NPV 0.94 (0.94 − 0.95).

Conclusion

We developed and validated a comprehensive screening questionnaire, COPD-CPHS, with good discrimination. The score system still needs to be validated by large cohort in the future.

Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2042504 .

Keywords:

• COPD
• screening
• scoring system
• validation

Statement of ethics

The study protocol was approved by the ethics review committee of the Beijing Capital Medical University and other participating institutes. We obtained written informed consent from all study participants.

Author contributions

DW, GF, SW and CW provided the idea and designed the study and had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. DW, GF, SW, TY and CW drafted the paper. DW, GF, SW, TY and CW did the analysis and all authors critically revised the manuscript for important intellectual content and gave final approval for the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Enquiries for data generated or analyzed during this study can be directed to the corresponding author.

Additional information

Funding

This work was supported by The National Key Technology R&D Program (2018YFC1315300).