American Journal of Epidemiology Vol. 155, No. 10 : 965-971
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
PRACTICE OF EPIDEMIOLOGY |
Validation of Self-reported Chronic Obstructive Pulmonary Disease in a Cohort Study of Nurses
1 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
2 General Medicine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
3 Department of Epidemiology, Harvard School of Public Health, Boston, MA.
4 Department of Environmental Health, Harvard School of Public Health, Boston, MA.
5 Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death, and its prevalence is increasing; however, few strategies are available for disease prevention or modification besides smoking interventions. To facilitate examination of modifiable risk factors for COPD in the Nurses' Health Study, the authors validated a questionnaire-based definition of COPD in a subset of this US cohort. Participants were surveyed biennially about lifestyle factors, including smoking, since 1976 and physician diagnosis of COPD since 1988. Self-reported cases were defined as reporting COPD on both the original (1988–1996) and supplemental (1998) questionnaires. The authors requested medical records for a 10% random sample of 2,790 cases and reviewed these records in a systematic, blinded fashion. Validated cases required obstructive spirometry, emphysema on chest radiograph or computed tomography, or physician diagnosis. COPD was confirmed for 78% of 273 cases. Spirometry or radiographic results were available for 84%; when available, mean forced expiratory volume in 1 second was 51% predicted (standard deviation, 19). Applying these results to a hypothetical cohort, the authors estimated the degree to which disease misclassification biases relative risks toward the null value, confirming that questionnaire-based COPD research should focus on minimizing false positives rather than false negatives. In conclusion, COPD can be studied in large, questionnaire-based cohorts of health professionals.
airway obstruction; cohort studies; epidemiologic methods; lung diseases, obstructive; pulmonary disease, chronic obstructive; questionnaires
Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; NHANES III, Third National Health and Nutrition Examination Survey
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