Challenges and pitfalls of using repeat spirometry recordings in routine primary care data to measure FEV1 decline in a COPD population
File(s)
Author(s)
Whittaker, Hannah
Kiddle, Steven
Quint, jennifer
Type
Journal Article
Abstract
Background
Electronic healthcare records (EHR) are increasingly used for epidemiological studies but are often viewed as lacking quality compared to randomised control trials and prospective cohorts. Studies of patients with chronic obstructive pulmonary disease (COPD) often use rate of forced expiratory volume in 1 second (FEV1) decline as an outcome however, its definition and robustness in EHR has not be investigated. We aimed to investigate how rate of FEV1 decline differs by the criteria used in an EHR database.
Methods
Clinical Practice Research Datalink and Hospital Episode Statistics were used. Patient populations were defined using 8 sets of criteria around repeated FEV1 measurements. At a minimum, patients had a diagnosis of COPD, were ≥35 years old, were current or ex-smokers, and had data recorded from 2004. FEV1 measurements recorded during follow-up were identified. Thereafter, eight populations were defined based on criteria around: i) the exclusion of patients or individual measurements with potential measurement error; ii) minimum number of FEV1 measurements; iii) minimum time interval between measurements; iv) specific timing of measurements; v) minimum follow-up time; and vi) the use of linked data. For each population, rate of FEV1 decline was estimated using mixed linear regression.
Results
For 7/8 patient populations, rates of FEV1 decline (age and sex adjusted) were similar and ranged from -18.7ml/year (95%CI -19.2 to -18.2) to -16.5ml/year (95%CI -17.3 to -15.7). Rates of FEV1 decline in populations that excluded patients with potential measurement error ranged from -79.4ml/year (95%CI -80.7 to -78.2) to -46.8ml/year (95%CI -47.6 to -46.0).
Conclusions
FEV1 decline remained similar in a COPD population regardless of number of FEV1 measurements, time intervals between measurements, follow-up period, exclusion of specific FEV1 measurements, and linkage to HES. However, exclusion of individuals with questionable data led to selection bias and faster rates of decline.
Electronic healthcare records (EHR) are increasingly used for epidemiological studies but are often viewed as lacking quality compared to randomised control trials and prospective cohorts. Studies of patients with chronic obstructive pulmonary disease (COPD) often use rate of forced expiratory volume in 1 second (FEV1) decline as an outcome however, its definition and robustness in EHR has not be investigated. We aimed to investigate how rate of FEV1 decline differs by the criteria used in an EHR database.
Methods
Clinical Practice Research Datalink and Hospital Episode Statistics were used. Patient populations were defined using 8 sets of criteria around repeated FEV1 measurements. At a minimum, patients had a diagnosis of COPD, were ≥35 years old, were current or ex-smokers, and had data recorded from 2004. FEV1 measurements recorded during follow-up were identified. Thereafter, eight populations were defined based on criteria around: i) the exclusion of patients or individual measurements with potential measurement error; ii) minimum number of FEV1 measurements; iii) minimum time interval between measurements; iv) specific timing of measurements; v) minimum follow-up time; and vi) the use of linked data. For each population, rate of FEV1 decline was estimated using mixed linear regression.
Results
For 7/8 patient populations, rates of FEV1 decline (age and sex adjusted) were similar and ranged from -18.7ml/year (95%CI -19.2 to -18.2) to -16.5ml/year (95%CI -17.3 to -15.7). Rates of FEV1 decline in populations that excluded patients with potential measurement error ranged from -79.4ml/year (95%CI -80.7 to -78.2) to -46.8ml/year (95%CI -47.6 to -46.0).
Conclusions
FEV1 decline remained similar in a COPD population regardless of number of FEV1 measurements, time intervals between measurements, follow-up period, exclusion of specific FEV1 measurements, and linkage to HES. However, exclusion of individuals with questionable data led to selection bias and faster rates of decline.
Date Issued
2021-09-01
Date Acceptance
2021-07-06
Citation
Pragmatic and Observational Research, 2021, 2021 (12), pp.119-130
ISSN
1179-7266
Publisher
Dove Medical Press
Start Page
119
End Page
130
Journal / Book Title
Pragmatic and Observational Research
Volume
2021
Issue
12
Copyright Statement
© 2021 Whittaker et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/
terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing
the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php)
terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing
the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php)
License URL
Identifier
https://www.dovepress.com/challenges-and-pitfalls-of-using-repeat-spirometry-recordings-in-routi-peer-reviewed-fulltext-article-POR
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
electronic healthcare records
spirometry
COPD
lung function
LUNG-FUNCTION DECLINE
COPD
electronic healthcare records
lung function
spirometry
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2021-09-01