Yang Zhao, Schooling C Mary, Lee Siu Yin, Kwok Man Ki
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
Ann Transl Med. 2022 Jan;10(1):4. doi: 10.21037/atm-21-3270.
No screening program is recommended for chronic obstructive pulmonary disease (COPD) in adults based on current clinical practice guidelines. Risk prediction models for COPD developed in Western settings may not be directly applicable to older Chinese adults. To evaluate the performance of an existing risk prediction model for COPD developed in a Western setting in Chinese adults and investigate whether a new risk prediction model performs better in predicting 5-year risk of COPD (EHS-COPD).
This study is based on 135,822 participants aged 65+ years from Hong Kong's Elderly Health Service (EHS) cohort. We assessed the performance of an existing risk prediction model in the entire cohort, and in a random sub-sample of 91,133 participants, we recalibrated the existing model and derived a new model using extended Cox proportional hazards regression. Candidate risk predictors from the literature and the EHS cohort were considered for inclusion. Risk prediction performance, discrimination, and calibration of the newly derived models were assessed in the remaining 44,689 participants.
The existing risk prediction model overestimated the 5-year risk of COPD in older Chinese adults (65+ years); after recalibration, it still overestimated the 5-year risk of COPD for both men and women. The new EHS-COPD risk prediction model, including time-varying factors (i.e., age and smoking status) and time-invariant factors (i.e., education level, public assistance, alcohol use, body mass index, physical activity, existing hypertension, recent falls, cognitive function, and self-rated health status), had an improved performance. For men, EHS-COPD explained 19.5% of COPD risk, the D statistic was 23.1, and Harrell's C statistic was 0.93. The corresponding values for women were 8.5%, 21.1, and 0.93.
The existing COPD risk prediction model overpredicted COPD risk in older Chinese and could not be recalibrated to predict well. A revised prediction model using time-invariant and time-varying factors provides a better tool for identifying older Chinese adults at high risk of developing COPD.
根据当前临床实践指南，不建议对成年人慢性阻塞性肺疾病（COPD）进行筛查。在西方环境中开发的COPD风险预测模型可能不适用于中国老年成年人。为了评估在西方环境中开发的现有COPD风险预测模型在中国成年人中的性能，并研究新的风险预测模型在预测COPD 5年风险方面是否表现更好（EHS-COPD）。
本研究基于香港老年健康服务（EHS）队列中135,822名65岁及以上的参与者。我们评估了现有风险预测模型在整个队列中的性能，并且在91,133名参与者的随机子样本中，我们重新校准了现有模型，并使用扩展的Cox比例风险回归得出了一个新模型。考虑纳入来自文献和EHS队列的候选风险预测因素。在其余44,689名参与者中评估新得出模型的风险预测性能、区分度和校准情况。
现有风险预测模型高估了中国老年成年人（65岁及以上）患COPD的5年风险；重新校准后，它仍然高估了男性和女性患COPD的5年风险。新的EHS-COPD风险预测模型，包括随时间变化的因素（即年龄和吸烟状况）和不随时间变化的因素（即教育水平、公共援助、饮酒、体重指数、身体活动、现患高血压、近期跌倒、认知功能和自评健康状况），性能有所改善。对于男性，EHS-COPD解释了19.5%的COPD风险，D统计量为23.1，Harrell's C统计量为0.93。女性的相应值分别为8.5%、21.1和0.93。
现有的COPD风险预测模型高估了中国老年人患COPD的风险，并且无法重新校准以进行良好预测。使用不随时间变化和随时间变化因素的修订预测模型为识别有患COPD高风险的中国老年成年人提供了更好的工具。
