Association between underdiagnosed and overdiagnosed chronic obstructive pulmonary disease with all-cause mortality
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Chronic obstructive pulmonary disease (COPD) underdiagnosis and overdiagnosis are common in clinical practice, but studies on their long-term prognosis remain limited. The study aimed to explore the all-cause mortality of underdiagnosed and overdiagnosed COPD in the general population. Methods: )/forced vital capacity (FVC) < lower limit of normal (LLN), and previously diagnosed COPD as physician-confirmed chronic bronchitis and/or emphysema. Participants were stratified into non-COPD (neither criterion), underdiagnosed COPD (airflow limitation without prior diagnosis), overdiagnosed COPD (prior diagnosis without airflow limitation), COPD (both criteria met). Logistic and Cox proportional hazards regressions were used to analyze risks of comorbidities/chronic respiratory symptoms and all-cause mortality between groups after covariates adjustment, respectively. Results: Of 24,661 participants (median follow-up 308 months), 84.6% were non-COPD, 9.5% underdiagnosed, 4.2% overdiagnosed, and 1.8% with confirmed COPD. Compared with non-COPD participants, overdiagnosed COPD participants had increased risks of comorbidities and chronic respiratory symptoms, while underdiagnosed participants had higher odds of chronic respiratory symptoms (all P<0.001). Both underdiagnosed [hazard ratio (HR): 1.25, 95% confidence interval (CI): 1.15-1.36, P<0.001] and overdiagnosed participants (HR: 1.18, 95% CI: 1.04-1.33, P=0.01) had higher all-cause mortality risk than non-COPD participants after covariates adjustment. Conclusions: Participants with COPD underdiagnosis and overdiagnosis had increased disease burden and mortality risk. Spirometry screening facilitates the standardization of COPD diagnosis, which might reduce underdiagnosis and overdiagnosis. If spirometry is unavailable in resource-limited settings, underlying etiology-based intervention should be initiated early.
Source: Journal of Thoracic Disease
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416455096