Factors associated with inadequate diagnosis of COPD: On-Sint cohort analysis

Figures & data

Table 1 Patient characteristics and diagnostic accuracy: bivariate analysis

Patient characteristics	Patients (n=1,214)	Inadequate diagnosis (n=623)	Adequate diagnosis (n=591)	P-value
Age (years)*	66.4 (9.7)	66.0 (9.9)	66.8 (9.5)	0.14
Male	955 (78.8%)	478 (76.7%)	477 (81.3%)	0.053
Time elapsed since diagnosis (years)*	8.01 (7.2)	9.04 (8.2)	6.9 (5.7)	0.004
Active smokers	318 (26.5%)	167 (27.2%)	151 (25.7%)	0.55
Smoking history (packs/year)*	36.3 (20.8)	32.1 (19.3)	40.7 (21.4)	<0.0001
Presence of other COPD risk factors	231 (19.2%)	129 (20.9%)	102 (17.4%)	0.12
Body mass index (kg/m^2)*	27.7 (4.1)	28.2 (3.8)	27.2 (4.3)	<0.0001
Dyspnea (mMRC scale)*	1.53 (0.8)	1.49 (0.8)	1.59 (0.8)	0.10
Presence of chronic sputum	876 (74.2%)	450 (74.9%)	426 (76.6%)	0.60
Exacerbations in the past year*	2.32 (1.9)	2.52 (2.0)	2.11 (1.8)	<0.0001
Hospitalizations in the past year*	0.08 (0.4)	0.1 (0.4)	0.05 (0.3)	0.55
Score on CAT questionnaire*	18.3 (7.6)	18.4 (7.4)	18.1 (7.8)	0.31
Number of comorbidities*	2.8 (1.8)	3.03 (1.9)	2.6 (1.7)	<0.0001
Sleep apnea	258 (21.5%)	146 (23.7%)	112 (19.2%)	0.06
Hypertension	747 (63.2%)	404 (65.7%)	353 (60.5%)	0.06
Heart failure	154 (12.7%)	93 (14.9%)	61 (10.3%)	0.01
Peripheral artery disease	129 (10.6%)	76 (12.2%)	53 (10.6%)	0.06
Cerebrovascular disease	61 (5.0%)	34 (5.5%)	27 (4.6%)	0.47
Gastroduodenal ulcer	106 (8.7%)	65 (10.4%)	41 (6.9%)	0.03
Chronic liver disease	51 (4.2%)	29 (4.7%)	22 (3.7%)	0.41
Diabetes	271 (22.3%)	159 (24.1%)	121 (20.5%)	0.13
Dyslipidemia	603 (50.3%)	334 (54.3%)	269 (46.1)	0.005
Active malignancy	48 (4.0%)	19 (3%)	29 (4.9)	0.09
Treated with short-acting bronchodilators	514 (42.3%)	239 (38.4%)	275 (46.5%)	0.004
Treated with long-acting bronchodilators	1,073 (88.4)	525 (84.3%)	548 (92.7%)	<0.0001
Treated with inhaled corticosteroids	635 (52.3%)	302 (48.5%)	333 (56.3%)	0.006
Treated with methylxanthines	69 (5.7%)	31 (5.0%)	38 (6.4%)	0.27
Treated with mucolytics	331 (27.1%)	178 (28.6%)	173 (25.9%)	0.29
Home oxygen therapy	181 (15.4%)	97 (16.2%)	84 (14.5%)	0.42
Pulmonary rehabilitation	181 (15.9%)	93 (15.7%)	88 (15.6%)	0.94

Note:

* Expressed as mean (standard deviation).

Abbreviations: COPD, chronic obstructive pulmonary disease; mMRC, modified Medical Research Council; CAT, COPD Assessment Test.

Table 2 Physician characteristics and diagnostic accuracy: bivariate analysis

Physician characteristics	Patients included (n=962)	Inadequate diagnosis (n=513)	Adequate diagnosis (n=449)	P-value
Age (years)*	53.2 (8.2)	54.4 (7.5)	51.8 (8.8)	<0.0001
Male	833 (86.6%)	452 (88.1%)	381 (84.9%)	0.14
Primary care physician	682 (70.9%)	434 (84.6%)	248 (55.2%)	<0.0001
Rural care center	236 (24.7%)	159 (31.4%)	77 (17.1%)	<0.0001
Experience >10 years	881 (92.6%)	483 (95.5%)	398 (89.4%)	<0.0001
Patients seen each week
≤50	176 (18.2%)	65 (12.7%)	111 (24.7%)	Reference
51–100	243 (25.3%)	110 (21.4%)	133 (29.6%)	0.08
>100	543 (56.5%)	338 (65.9%)	205 (45.7%)	<0.0001
Patients with COPD seen each week*	17.6 (10.9)	15.8 (8.4)	16.8 (11.0)	0.21
Schedules follow-up visits in severe COPD cases	674 (72.9%)	323 (62.2%)	351 (80.5%)	0.008
Uses quality of life questionnaires for COPD patients	327 (34.1%)	149 (29%)	178 (40.0%)	<0.0001
Performs a multidimensional assessment or uses dyspnea scale	562 (59.1%)	257 (51.1%)	305 (68.2%)	<0.0001

Note:

* Expressed as the mean (standard deviation).

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 3 Multivariate analysis of factors related to inadequate diagnosis

Variable	Adjusted OR	CI 95%	P-value
Body mass index (kg/m^2)	1.06	1.02–1.10	0.001
Time elapsed since diagnosis (years)	1.03	1.01–1.05	0.01
Number of exacerbations in the past year	1.01	1.01–1.02	0.02
Number of comorbidities	1.05	1.01–1.15	0.04
Number of packs/year	0.98	0.97–0.99	0.002
Treatment with short-acting bronchodilators	0.61	0.44 –0.76	0.002
Treatment with long-acting bronchodilators	0.46	0.27–0.76	0.003
Follow-up by primary care physicians	3.0	2.11–4.34	<0.0001
Rural monitoring center	1.63	1.12–2.38	0.009
Scheduled follow-up visits in severe COPD cases	0.66	0.46–0.93	0.001
Monitoring by a physician who uses quality of life questionnaires	0.55	0.40–0.76	<0.0001

Abbreviations: COPD, chronic obstructive pulmonary disease; CI, confidence interval; OR, odds ratio.