漏诊和过度诊断COPD对医疗卫生服务造成的负担
2018/05/30
摘要
背景：慢性阻塞性肺病（COPD）的误诊时有发生。本文的目的是量化北美人群中漏诊和过度诊断的COPD对医疗卫生服务造成的负担情况。
方法：进行了一项以人群为基础的队列研究。COPD的肺功能数据来自于随机选择参加了加拿大阻塞性肺病研究，来自于加拿大安大略省的40岁以的成年人。医生诊断COPD的数据来自于健康管理数据库。受试者被分为四组：正确诊断，漏诊，过度诊断和无COPD的健康人，比较各组住院年龄、性别标准化率、急诊就诊率和门诊就诊率。
结果：在1,403名受试者中，13.7％漏诊，5.1％过度诊断，3.7％正确诊断为COPD。其中过度诊断的患者住院率，急诊就诊率和门诊就诊率明显高于中度至严重程度漏诊的COPD患者，其住院率高于非COPD患者。
结论：漏诊和过度诊断的COPD显着加重了的医疗卫生服务负担。鉴于误诊的COPD患者比正确诊断的COPD多5倍，提示COPD疾病的医疗卫生负担可以通过提高诊断正确率来缓解。
Health Services Burden of Undiagnosed and Overdiagnosed COPD
Background：Misdiagnosis of chronic obstructive pulmonary disease (COPD) is common. We aimed to quantify the health services burden of undiagnosed and overdiagnosed COPD in a real world, North American population.
Methods：A population-based cohort study was conducted. Presence of COPD using spirometry was ascertained in randomly selected adults age 40 or older from Ontario, Canada who participated in the Canadian Obstructive Lung Disease study. Presence of physician diagnosed COPD was ascertained for the same people using linked health administrative data. Participants were then categorized into four groups: correctly diagnosed, undiagnosed, overdiagnosed and no COPD by either criteria. Age and sex standardized rates of hospitalizations, emergency department visits and ambulatory care visits in each group were determined and compared.
Results：Of 1,403 participants, 13.7% had undiagnosed, 5.1% overdiagnosed, and 3.7% correctly diagnosed COPD. People with overdiagnosed COPD had significantly higher rates of hospitalizations, emergency department visits and ambulatory care visits, and people with moderate to severe undiagnosed COPD had higher rates of hospitalizations, than people in the non-COPD population.
Conclusions：Undiagnosed and overdiagnosed COPD contribute to significant health care burden. Given that misdiagnosed COPD was fivefold more common than correctly diagnosed COPD, these findings point to a substantial misdiagnosis-associated burden of disease that might be prevented, at least in part, with correct diagnosis.
背景：慢性阻塞性肺病（COPD）的误诊时有发生。本文的目的是量化北美人群中漏诊和过度诊断的COPD对医疗卫生服务造成的负担情况。
方法：进行了一项以人群为基础的队列研究。COPD的肺功能数据来自于随机选择参加了加拿大阻塞性肺病研究，来自于加拿大安大略省的40岁以的成年人。医生诊断COPD的数据来自于健康管理数据库。受试者被分为四组：正确诊断，漏诊，过度诊断和无COPD的健康人，比较各组住院年龄、性别标准化率、急诊就诊率和门诊就诊率。
结果：在1,403名受试者中，13.7％漏诊，5.1％过度诊断，3.7％正确诊断为COPD。其中过度诊断的患者住院率，急诊就诊率和门诊就诊率明显高于中度至严重程度漏诊的COPD患者，其住院率高于非COPD患者。
结论：漏诊和过度诊断的COPD显着加重了的医疗卫生服务负担。鉴于误诊的COPD患者比正确诊断的COPD多5倍，提示COPD疾病的医疗卫生负担可以通过提高诊断正确率来缓解。
(中日友好医院呼吸与危重症医学科 圆方 摘译 林江涛 审校)
(Chest，Available online 6 February 2018 )
(Chest，Available online 6 February 2018 )
Health Services Burden of Undiagnosed and Overdiagnosed COPD
Andrea S. Gershon, MD, Deva Thiruchelvam, MSc, Kenneth R. Chapman, MD, Shawn D. Aaron, MD, , Matthew B. Stanbrook, MD , Jean Bourbeau, MD, Wan Tan, MD , Teresa To, PhD
AbstractBackground：Misdiagnosis of chronic obstructive pulmonary disease (COPD) is common. We aimed to quantify the health services burden of undiagnosed and overdiagnosed COPD in a real world, North American population.
Methods：A population-based cohort study was conducted. Presence of COPD using spirometry was ascertained in randomly selected adults age 40 or older from Ontario, Canada who participated in the Canadian Obstructive Lung Disease study. Presence of physician diagnosed COPD was ascertained for the same people using linked health administrative data. Participants were then categorized into four groups: correctly diagnosed, undiagnosed, overdiagnosed and no COPD by either criteria. Age and sex standardized rates of hospitalizations, emergency department visits and ambulatory care visits in each group were determined and compared.
Results：Of 1,403 participants, 13.7% had undiagnosed, 5.1% overdiagnosed, and 3.7% correctly diagnosed COPD. People with overdiagnosed COPD had significantly higher rates of hospitalizations, emergency department visits and ambulatory care visits, and people with moderate to severe undiagnosed COPD had higher rates of hospitalizations, than people in the non-COPD population.
Conclusions：Undiagnosed and overdiagnosed COPD contribute to significant health care burden. Given that misdiagnosed COPD was fivefold more common than correctly diagnosed COPD, these findings point to a substantial misdiagnosis-associated burden of disease that might be prevented, at least in part, with correct diagnosis.
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β-受体阻滞剂治疗慢性阻塞性肺疾病：一项来自TONADO®研究项目的队列研究
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