Martinez Carlos H, Mannino David M, Jaimes Fabian A, Curtis Jeffrey L, Han MeiLan K, Hansel Nadia N, Diaz Alejandro A
1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan.
2 Department of Preventive Medicine and Environmental Health, University of Kentucky College of Medicine, Lexington, Kentucky.
Ann Am Thorac Soc. 2015 Dec;12(12):1788-95. doi: 10.1513/AnnalsATS.201506-388OC.
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.
To define factors associated with undiagnosed obstructive lung disease and its long-term mortality.
Cross-sectional analysis of participants, aged 20 to 79 years, in two National Health and Nutritional Examination Surveys (NHANES), NHANES III (1988-1994) and NHANES 2007-2012, with longitudinal follow-up of NHANES III participants.
We classified participants with spirometry-confirmed obstructive disease, based on 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 comorbidity burden (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-cause mortality 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. In multivariate 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.
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.
了解与未诊断的阻塞性肺病相关的因素及其对死亡率的影响，可为正在进行的关于筛查和病例发现的益处与风险的讨论提供信息。
确定与未诊断的阻塞性肺病及其长期死亡率相关的因素。
对参加两次国家健康和营养检查调查（NHANES）的20至79岁参与者进行横断面分析，这两次调查分别是NHANES III（1988 - 1994年）和NHANES 2007 - 2012年，并对NHANES III的参与者进行纵向随访。
根据固定比例定义（FEV1/FVC < 0.7），我们将通过肺量计确诊为阻塞性疾病的参与者分为“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，死亡率是感兴趣的结果。我们使用针对人口统计学、吸烟状况和肺功能进行调整的逻辑模型，测试自我报告的健康状况和合并症负担（暴露因素）对未被诊断几率的影响。我们使用Cox比例回归分析估计了参加NHANES III且进行了肺量计检查的已诊断和未诊断受试者全因死亡率的风险比（HRs）。在通过肺量计定义为阻塞性疾病的人群中，NHANES III中有71.2%（标准误，1.8），NHANES 2007 - 2012中有72.0%（标准误，1.9）未被诊断。在多变量模型中，两次调查中未诊断的阻塞性疾病均与自我报告的良好/优秀健康状况、较低的合并症负担、较高的肺功能以及属于少数种族/族裔持续相关。在NHANES III参与者中（中位随访时间为14.5年），未被诊断的参与者（HR，1.23；95%置信区间，1.08 - 1.40）和正确诊断的参与者（HR，1.74；95%置信区间，1.45 - 2.09）的全因死亡率风险均高于无阻塞的参与者。
未诊断的阻塞性肺病在美国成年人中很常见，并且在20多年间保持不变。尽管未被诊断的受试者看起来比已诊断的受试者更健康，但与无阻塞的受试者相比，他们的死亡风险增加了。在判断阻塞性肺病病例发现计划的影响时，需要考虑这些发现。
