Undiagnosed Obstructive Lung Disease in the United States Associated Factors and Long-term Mortality
Undiagnosed Obstructive Lung Disease in the United States Associated Factors and Long-term Mortality
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DOI：
10.1513/annalsats.201506-388oc
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发表时间：
2015-12-01
影响因子：
8.3
通讯作者：
Diaz, Alejandro A.
中科院分区：
文献类型：
--
作者：
Martinez, Carlos H.;Mannino, David M.;Diaz, Alejandro A.
理论基础：了解与未诊断的阻塞性肺疾病相关的因素及其对死亡率的影响，有助于正在进行的关于筛查和病例发现的益处和风险的讨论。目的：定义与未诊断的阻塞性肺疾病及其长期死亡率相关的因素。方法：横断面分析两次国家健康和营养调查(NHANES)、NHANESIII(1988-1994)和NHANES 2007-2012的参与者，并对NHANES III的参与者进行纵向随访。测量和主要结果：我们根据固定比率定义(FEV1/FVC<；0.7)、“已诊断”(医生诊断为哮喘或慢性阻塞性肺疾病)和“未诊断”(无医生诊断记录)。对于NHANES III参与者的纵向分析，死亡率是令人感兴趣的结果。我们使用调整了人口统计学、吸烟状况和肺功能的Logistic模型，测试了自我报告的健康状况和共病负担(暴露)对未被诊断的几率的影响。我们使用COX比例回归分析评估了参加NHANES III并进行肺活量测定的确诊和未确诊受试者全死因死亡的风险比(HR)。在有肺活量测定定义的梗阻的患者中，NHANES III中71.2%(SE，1.8)和NHANES 2007-2012中72.0%(SE，1.9)未被诊断。在多变量模型中，在两项调查中，未诊断的阻塞性疾病与自我报告的良好/优秀的健康状况、较低的共病负担、较高的肺功能和种族/少数民族有关。在NHANES III参与者中(平均随访14.5年)，无论是未诊断的(HR，1.23；95%可信区间，1.08-1.40)还是正确诊断的参与者(HR，1.74，95%可信区间，1.45-2.09)，全因死亡的风险都高于无梗阻的参与者。结论：未诊断的阻塞性肺病在美国成年人中很常见，并且在20年中没有变化。尽管未确诊的受试者看起来比确诊的受试者更健康，但与无梗阻的受试者相比，他们的死亡风险增加了。在判断病例发现计划对阻塞性肺疾病的影响时，需要考虑这些发现。
Rationale: Understanding factors associated with undiagnosed obstructive lung disease and its impact on mortality could inform the ongoing discussions about benefits and risks of screening and case finding.Objectives: To define factors associated with undiagnosed obstructive lung disease and its long-term mortality.Methods: Cross-sectional analysis of participants, aged 20 to 79 years, in two National Health and Nutritional Examination Surveys (NHANES), NHANESIII (1988-1994) and NHANES 2007-2012, with longitudinal follow-up of NHANES III participants.Measurements and Main Results: We classified participants with spirometry-confirmed obstructive disease, basedon the fixed ratio definition (FEV1/FVC < 0.7), as "diagnosed" (physician diagnosis of either asthma or chronic obstructive pulmonary disease), and "undiagnosed" (no recorded physician diagnosis). For the longitudinal analysis of NHANES III participants, mortality was the outcome of interest. We tested the contribution of self-reported health status and comorbidityburden(exposure) to the odds of being undiagnosed using logistic models adjusted for demographics, smoking status, and lung function. We estimated hazard ratios (HRs) for all-causemortality for diagnosed and undiagnosed subjects participating in NHANES III who had spirometry using Cox-proportional regression analysis. Among those with spirometry-defined obstruction, 71.2% (SE, 1.8) in NHANES III and 72.0% (SE, 1.9) in NHANES 2007-2012 were undiagnosed. Inmultivariate models, undiagnosed obstructive disease was consistently associated in both surveys with self-reported good/excellent health status, lower comorbidity burden, higher lung function, and being of racial/ethnic minority. Among NHANES III participants (median follow up, 14.5 yr), both undiagnosed (HR, 1.23; 95% confidence interval, 1.08-1.40) and correctly diagnosed participants (HR, 1.74; 95% confidence interval, 1.45-2.09) had higher risk for all-cause mortality than participants without obstruction.Conclusions: Undiagnosed obstructive lung disease is common among American adults and remained unchanged over 2 decades. Although undiagnosed subjects appear healthier than those with a diagnosis, their risk of death was increased compared with subjects without obstruction. These findings need to be considered when judging the implications of case-finding programs for obstructive lung disease.