COPD in England: a comparison of expected, model-based prevalence and observed prevalence from general practice data

Nacul, Luis, Soljak, Michael, Samarasundera, Edgar, Hopkinson, Nicholas S., Lacerda, Eliana, Indulkar, Tejal, Flowers, Julian, Walford, Hannah and Majeed, Azeem (2010) COPD in England: a comparison of expected, model-based prevalence and observed prevalence from general practice data. Journal of Public Health, 33(1), pp. 108-116. ISSN (print) 1741-3842

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BACKGROUND: Primary care data show that 765 000 people in England have a general practice (GP) diagnosis of chronic obstructive pulmonary disease (COPD). We hypothesized that this underestimates actual prevalence, and compared expected prevalence of COPD for English local authority areas with prevalence of diagnosed COPD. METHODS: Cross-sectional comparison of GP observed and model-based prevalence estimates (using spirometry data without clinical diagnosis) from the Health Survey for England. Local underdiagnosis of COPD was estimated as the ratio of observed to expected cases. We investigated geographical patterns using classical and geographically weighted regression analysis. RESULTS: Both observed and expected prevalence of COPD varied widely between areas. There was evidence of a 'north-south' divide, with both observed and modelled prevalence higher in the north. The ratio of diagnosed to expected prevalence varied from 0.20 to 0.95, with a mean of 0.52. Underdiagnosis was more pronounced in urban areas, and is particularly severe in London. The inclusion of GP numbers in the analysis yielded a stronger regression relationship, suggesting primary care supply affects diagnosis. CONCLUSION: Both observed and modelled COPD prevalence varies considerably across England. Cost-effective case-finding strategies should be evaluated, especially in areas where the ratio of observed to expected cases is low.

Item Type: Article
Uncontrolled Keywords: chronic obstructive pulmonary disease, epidemiological, prevalence, spatial analysis, statistics
Research Area: Allied health professions and studies
Geography and environmental studies
Health services research
Faculty, School or Research Centre: Faculty of Science (until 2011) > School of Geography, Geology and Environment
Related URLs:
Depositing User: Maren Schroeder
Date Deposited: 07 Dec 2012 13:56
Last Modified: 07 Dec 2012 13:56

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