Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (>= 40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorPAN, Zihan
dc.contributor.authorDICKENS, Andrew P.
dc.contributor.authorCHI, Chunhua
dc.contributor.authorKONG, Xia
dc.contributor.authorENOCSON, Alexandra
dc.contributor.authorCOOPER, Brendan
dc.contributor.authorADAB, Peymane
dc.contributor.authorCHENG, Kar Keung
dc.contributor.authorSITCH, Alice J.
dc.contributor.authorJOWETT, Sue
dc.contributor.authorADAMS, Rachel
dc.contributor.authorCORREIA-DE-SOUSA, Jaime
dc.contributor.authorFARLEY, Amanda
dc.contributor.authorGALE, Nicola K.
dc.contributor.authorJOLLY, Kate
dc.contributor.authorMAGLAKELIDZE, Mariam
dc.contributor.authorMAGLAKELIDZE, Tamaz
dc.contributor.authorMARTINS, Sonia
dc.contributor.authorSTAVRIKJ, Katarina
dc.contributor.authorSTELMACH, Rafael
dc.contributor.authorTURNER, Alice M.
dc.contributor.authorWILLIAMS, Sian
dc.contributor.authorJORDAN, Rachel
dc.date.accessioned2021-10-20T14:05:19Z
dc.date.available2021-10-20T14:05:19Z
dc.date.issued2021
dc.description.abstractObjectives To examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population. Design Screening test accuracy study. Setting Urban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), Guangzhou (south) and Shenyang (northeast). Participants Community residents aged 40 years and above who attended community health centres for any reason were invited to participate. 2445 participants (mean age 59.8 (SD 9.6) years, 39.1% (n=956) male) completed the study (February-December 2019), 68.9% (n=1684) were never-smokers and 3.6% (n=88) had an existing COPD diagnosis. 13.7% (n=333) of participants had spirometry-confirmed airflow obstruction. Interventions Participants completed six index tests (screening questionnaires (COPD Diagnostic Questionnaire, COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE), Chinese Symptom-Based Questionnaire (C-S130), COPD-SQ), microspirometry (COPD-6), peak flow (model of peak flow meters used in the study (USPE)) and the reference test (ndd Easy On-PC). Primary and secondary outcomes Cases were defined as those with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal (LLN-GLI) on the reference test. Performance of individual screening tests and their combinations was evaluated, with cost-effectiveness analyses providing cost per additional true case detected. Results Airflow measurement devices (sensitivities 64.9% (95% CI 59.5% to 70.0%) and 67.3% (95% CI 61.9% to 72.3%), specificities 89.7% (95% CI 88.4% to 91.0%) and 82.6% (95% CI 80.9% to 84.2%) for microspirometry and peak flow, respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1% (95% CI 57.6% to 68.3%) specificity 74.2% (95% CI 72.3% to 76.1%)). The combination of C-SBQ and microspirometry used in parallel maximised sensitivity (81.4%) (95% CI 76.8% to 85.4%) and had specificity of 68.0% (95% CI 66.0% to 70.0%), with an incremental cost-effectiveness ratio of (sic)64.20 (CNY385) per additional case detected compared with peak flow. Conclusions Simple screening tests to identify undiagnosed COPD within the primary care setting in China is possible, and a combination of C-SBQ and microspirometry is the most sensitive and cost-effective. Further work is required to explore optimal cut-points and effectiveness of programme implementation.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipNational Institute for Health Research (NIHR) NIHR global group on global COPD in primary care, University of Birmingham [16/137/95]
dc.description.sponsorshipUK Government
dc.description.sponsorshipNIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust
dc.description.sponsorshipUniversity of Birmingham
dc.identifier.citationBMJ OPEN, v.11, n.9, article ID e051811, 12p, 2021
dc.identifier.doi10.1136/bmjopen-2021-051811
dc.identifier.issn2044-6055
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/42580
dc.language.isoeng
dc.publisherBMJ PUBLISHING GROUPeng
dc.relation.ispartofBMJ Open
dc.rightsopenAccesseng
dc.rights.holderCopyright BMJ PUBLISHING GROUPeng
dc.subject.otherobstructive pulmonary-diseaseeng
dc.subject.otherglobal burdeneng
dc.subject.otherprevalenceeng
dc.subject.othervalidationeng
dc.subject.otherunderdiagnosiseng
dc.subject.otherquestionnaireeng
dc.subject.otherpopulationeng
dc.subject.wosMedicine, General & Internaleng
dc.titleAccuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (>= 40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well groupeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryMacedônia
hcfmusp.affiliation.countryGeórgia
hcfmusp.affiliation.countryPortugal
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countryChina
hcfmusp.affiliation.countryisocn
hcfmusp.affiliation.countryisogb
hcfmusp.affiliation.countryisopt
hcfmusp.affiliation.countryisoge
hcfmusp.affiliation.countryisomk
hcfmusp.author.externalPAN, Zihan:Peking Univ First Hosp, Dept Gen Practice, Beijing, Peoples R China; Peking Univ Third Hosp, Pulm & Crit Care Med, Beijing, Peoples R China
hcfmusp.author.externalDICKENS, Andrew P.:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalCHI, Chunhua:Peking Univ First Hosp, Dept Gen Practice, Beijing, Peoples R China
hcfmusp.author.externalKONG, Xia:Peking Univ First Hosp, Dept Gen Practice, Beijing, Peoples R China
hcfmusp.author.externalENOCSON, Alexandra:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalCOOPER, Brendan:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England; Univ Hosp Birmingham NHS Fdn Trust, Queen Elizabeth Hosp Birmingham, Lung Invest Unit, Birmingham, W Midlands, England
hcfmusp.author.externalADAB, Peymane:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalCHENG, Kar Keung:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England; Peking Univ Hlth Sci Ctr, Gen Practice Dev & Res Ctr, Beijing, Peoples R China
hcfmusp.author.externalSITCH, Alice J.:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England; Univ Hosp Birmingham NHS Fdn Trust, NIHR Birmingham Biomed Res Ctr, Birmingham, W Midlands, England; Univ Birmingham, Birmingham, W Midlands, England
hcfmusp.author.externalJOWETT, Sue:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalADAMS, Rachel:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalCORREIA-DE-SOUSA, Jaime:Univ Minho, Life & Hlth Sci Res Inst ICVS, Sch Med, Braga, Portugal; Int Primary Care Resp Grp, London, England; PT Govt Associate Lab, ICVS 3Bs, Braga, Portugal
hcfmusp.author.externalFARLEY, Amanda:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalGALE, Nicola K.:Univ Birmingham, Sch Social Policy, Coll Social Sci, Hlth Serv Management Ctr, Birmingham, W Midlands, England
hcfmusp.author.externalJOLLY, Kate:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalMAGLAKELIDZE, Mariam:Georgian Resp Assoc, Tbilisi, Georgia; Petre Shotadze Tbilisi Med Acad, Tbilisi, Georgia
hcfmusp.author.externalMAGLAKELIDZE, Tamaz:Georgian Resp Assoc, Tbilisi, Georgia
hcfmusp.author.externalMARTINS, Sonia:ABC Med Sch, Family Med, Sao Paulo, Brazil
hcfmusp.author.externalSTAVRIKJ, Katarina:Ss Cyril & Methodius Univ Skopje, Ctr Family Med, Fac Med, Skopje, North Macedonia
hcfmusp.author.externalTURNER, Alice M.:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.author.externalWILLIAMS, Sian:Int Primary Care Resp Grp, London, England
hcfmusp.author.externalJORDAN, Rachel:Univ Birmingham, Inst Appl Hlth Res, Birmingham, W Midlands, England
hcfmusp.citation.scopus12
hcfmusp.contributor.author-fmusphcRAFAEL STELMACH
hcfmusp.description.articlenumbere051811
hcfmusp.description.issue9
hcfmusp.description.volume11
hcfmusp.origemWOS
hcfmusp.origem.pubmed34556515
hcfmusp.origem.scopus2-s2.0-85116089374
hcfmusp.origem.wosWOS:000700193500015
hcfmusp.publisher.cityLONDONeng
hcfmusp.publisher.countryENGLANDeng
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