Background
Methods
Subjects and study design
KNHANES and HIRA data
Parameter definition
Outcomes
Ethics
Statistical analyses
Results
Demographics of subjects by group
Normal | PRISm | Unrevealed COPD | P-value | P-value* | P-value+ | P-value‡ | |
---|---|---|---|---|---|---|---|
Age | 54.57 ± 10.52 | 55.97 ± 10.85 | 64.48 ± 9.54 | < 0.001 | 0.083 | < 0.001 | < 0.001 |
Male, n (%) | 1560 (93.6) | 286 (91.4) | 654 (95.2) | 0.063 | 0.426 | 0.432 | 0.054 |
Height (cm) | 167.14 ± 6.94 | 166.79 ± 6.94 | 165.97 ± 6.56 | < 0.001 | 0.998 | <.0.001 | 0.236 |
Weight (kg) | 68.29 ± 9.91 | 68.66 ± 11.6 | 63.7 ± 9.8 | < 0.001 | 0.998 | < 0.001 | < 0.001 |
Smoking history | |||||||
Current smoking, n (%) | 858 (51.5) | 193 (61.7) | 367 (53.4) | 0.004 | 0.003 | 0.999 | 0.045 |
Pack-years | 28.62 ± 17.11 | 33.20 ± 20.34 | 36.58 ± 21.14 | < 0.001 | < 0.001 | < 0.001 | 0.026 |
Co-morbidity, n (%) | |||||||
Hypertension | 453 (27.2) | 91 (29.1) | 209 (30.4) | 0.269 | 0.998 | 0.336 | 0.999 |
Hyperlipidemia | 166 (10.0) | 34 (10.9) | 47 (6.8) | 0.035 | 0.998 | 0.048 | 0.092 |
Stroke | 48 (2.9) | 14 (4.5) | 18 (2.6) | 0.252 | 0.414 | 0.999 | 0.368 |
Acute coronary syndrome | 17 (1.0) | 8 (2.6) | 16 (2.3) | 0.019 | 0.077 | 0.042 | 0.999 |
Diabetes mellitus | 174 (10.4) | 63 (20.1) | 84 (12.2) | < 0.001 | < 0.001 | 0.624 | 0.003 |
Pulmonary tuberculosis | 124 (7.4) | 21 (6.7) | 109 (15.9) | < 0.001 | 0.999 | < 0.001 | < 0.001 |
Asthma | 20 (1.2) | 15 (4.8) | 65 (9.5) | < 0.001 | < 0.001 | < 0.001 | 0.024 |
Lung function test | |||||||
FVC % predicted | 92.96 ± 10.02 | 72.55 ± 9.45 | 88.51 ± 15.02 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
FEV1% predicted | 94.66 ± 9.14 | 72.8 ± 6.72 | 74.18 ± 16.57 | < 0.001 | < 0.001 | < 0.001 | 0.035 |
FEV1/FVC | 0.79 ± 0.05 | 0.77 ± 0.06 | 0.61 ± 0.09 | < 0.001 | < 0.001 | < 0.001 | 0.006 |
Respiratory symptoms, n (%) | |||||||
Cough for more than 3 months | 1 (0.1) | 2 (0.6) | 19 (2.8) | < 0.001 | 0.047 | < 0.001 | 0.091 |
Sputum for more than 3 months | 4 (0.2) | 2 (0.6) | 18 (2.6) | < 0.001 | 0.999 | < 0.001 | 0.104 |
Dyspnea | 10 (0.6) | 3 (1.0) | 31 (4.5) | < 0.001 | 0.999 | < 0.001 | 0.012 |
Wheezing | 116 (7.0) | 37 (11.8) | 154 (22.4) | < 0.001 | 0.009 | < 0.001 | < 0.001 |
Chronic bronchitis | 4 (0.2) | 2 (0.6) | 21 (3.1) | < 0.001 | 0.717 | < 0.001 | 0.054 |
Total | 1666 | 313 | 687 |
COPD incidence, medication and hospital utilization, and cost
Normal | PRISm | Unrevealed COPD | P-value | P-value* | P-value+ | P-value‡ | |
---|---|---|---|---|---|---|---|
COPD incidence (/1000PY) | 4.4 | 17.0 | 45.1 | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
OPD visit, n (%) | 51 (3.1) | 22 (7.0) | 131 (19.1) | < 0.001 | 0.002 | < 0.001 | < 0.001 |
No. of OPD visit | 0.10 ± 0.91 | 0.48 ± 2.96 | 1.86 ± 6.37 | < 0.001 | 0.243 | < 0.001 | < 0.001 |
Hospitalization, n (%) | 79 (4.7) | 29 (9.3) | 83 (12.1) | < 0.001 | 0.004 | < 0.001 | 0.571 |
ER visit, n (%) | 23 (1.4) | 12 (3.8) | 36 (5.2) | < 0.001 | 0.008 | < 0.001 | 0.999 |
ICU admission, n (%) | 12 (0.7) | 6 (1.9) | 19 (2.8) | < 0.001 | 0.122 | < 0.001 | 0.999 |
Total hospital visit, n (%) | 121 (7.3) | 41 (13.1) | 169 (24.6) | < 0.001 | 0.002 | < 0.001 | < 0.001 |
ICS, n (%) | 4 (0.2) | 5 (1.6) | 20 (2.9) | < 0.001 | 0.003 | < 0.001 | 0.651 |
ICS + LABA, n (%) | 2 (0.1) | 11 (3.5) | 50 (7.3) | < 0.001 | < 0.001 | < 0.001 | 0.063 |
LAMA, n (%) | – | 4 (1.3) | 44 (6.4) | – | – | – | < 0.001 |
SAMA, n (%) | 12 (0.7) | 12 (3.8) | 36 (5.2) | < 0.001 | < 0.001 | < 0.001 | 0.999 |
SABA, n (%) | 14 (0.8) | 11 (3.5) | 54 (7.9) | < 0.001 | < 0.001 | < 0.001 | 0.029 |
Systemic bronchodilator, n (%) | 28 (1.7) | 11 (3.5) | 72 (10.5) | < 0.001 | 0.094 | < 0.001 | < 0.001 |
Methylxanthine, n (%) | 33 (2.0) | 17 (5.4) | 101 (14.7) | < 0.001 | 0.001 | < 0.001 | < 0.001 |
Total prescribed medication, n (%) | 57 (3.4) | 26 (8.3) | 127 (18.5) | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
Hospitalization medical Cost (for 3 years) (USD) | 186.17 ± 1411.24 | 398.61 ± 1975.51 | 750.71 ± 3216.02 | < 0.001 | 0.297 | < 0.001 | 0.041 |
Comparison of baseline characteristics, medical utilization, and costs between subjects with and without medically diagnosed COPD
Subjects with medically diagnosed COPD | Subjects without medically diagnosed COPD | P-value | |
---|---|---|---|
Age | 68.58 ± 7.77 | 56.70 ± 11.00 | < 0.001 |
Male, n (%) | 123 (93.9) | 2377 (93.8) | 0.954 |
Height (cm) | 164.04 ± 6.25 | 166.94 ± 6.86 | < 0.001 |
Weight (kg) | 60.35 ± 9.89 | 67.5 ± 10.2 | < 0.001 |
Smoking history | |||
Current smoking, n (%) | 67 (51.2) | 1351 (53.3) | 0.631 |
Pack-years | 41.1 ± 23.69 | 30.7 ± 18.52 | < 0.001 |
Co-morbidity, n (%) | |||
Pulmonary tuberculosis | 28 (21.4) | 226 (8.9) | < 0.001 |
Asthma | 3 (26.0) | 66 (2.6) | < 0.001 |
Lung function test | |||
FVC % predicted | 81.14 ± 15.77 | 89.85 ± 12.85 | < 0.001 |
FEV1% predicted | 66.37 ± 19.36 | 87.87 ± 14.17 | < 0.001 |
FEV1/FVC | 0.59 ± 0.16 | 0.75 ± 0.09 | < 0.001 |
Respiratory symptoms, n (%) | |||
Cough for more than 3 months | 14 (10.7) | 8 (0.3) | < 0.001 |
Sputum for more than 3 months | 11 (8.4) | 13 (0.5) | < 0.001 |
Dyspnea | 23 (17.6) | 21 (0.8) | < 0.001 |
Wheezing | 60 (45.8) | 247 (9.7) | < 0.001 |
Chronic bronchitis | 14 (10.7) | 13 (0.5) | < 0.001 |
OPD visit, n (%) | 116 (88.6) | 88 (3.5) | < 0.001 |
No. of OPD visit | 10.88 ± 11.77 | 0.07 ± 0.59 | < 0.001 |
Hospitalization, n (%) | 67 (51.2) | 124 (4.9) | < 0.001 |
ER visit, n (%) | 35 (26.7) | 36 (1.4) | < 0.001 |
ICU admission, n (%) | 17 (13.0) | 20 (0.8) | < 0.001 |
Total hospital visit, n (%) | 131 (100) | 200 (7.9) | |
ICS, n (%) | 25 (19.1) | 4 (0.2) | < 0.001 |
ICS + LABA, n (%) | 54 (41.2) | 9 (0.4) | < 0.001 |
LAMA, n (%) | 42 (32.1) | 6 (0.2) | < 0.001 |
SAMA, n (%) | 44 (33.6) | 16 (0.6) | < 0.001 |
SABA, n (%) | 60 (45.8) | 19 (0.8) | < 0.001 |
Systemic bronchodilator, n (%) | 75 (57.3) | 36 (1.4) | < 0.001 |
Methylxanthine, n (%) | 110 (84.0) | 41 (1.6) | < 0.001 |
Total prescribed medication, n (%) | 131 (100.0) | 79 (3.1) | – |
Hospitalization medical Cost (for 3 years) (USD) | 4041.23 ± 6633.39 | 166.17 ± 1286.46 | < 0.001 |
Total | 131 | 2535 |
Significant factors for COPD diagnosis in subjects overall
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
OR | 95% CI | P-value | OR | 95% CI | P-value | |
Age (years)
|
1.11
|
(1.09,1.13)
|
< 0.001
|
1.10
|
(1.07,1.13)
|
< 0.001
|
Male | 1.02 | (0.49,2.13) | 0.954 | |||
Height (cm) | 0.95 | (0.92,0.97) | < 0.001 | 1.01 | (0.97,1.05) | 0.786 |
Weight (kg) | 0.93 | (0.91,0.95) | < 0.001 | 0.98 | (0.95,1.01) | 0.143 |
Smoking history | ||||||
Current smoking | 0.92 | (0.65,1.3) | 0.631 | |||
Pack-years | 1.02 | (1.01,1.03) | < 0.001 | 1.01 | (1.00,1.02) | 0.059 |
Co-morbidity | ||||||
Pulmonary tuberculosis | 2.78 | (1.79,4.31) | < 0.001 | 1.17 | (0.66,2.10) | 0.587 |
Asthma | 13.11 | (8.27,20.79) | < 0.001 | 1.88 | (0.97,3.64) | 0.060 |
Lung function test | ||||||
FVC % predicted |
0.95
|
(0.94,0.97)
|
< 0.001
|
1.03
|
(1.01,1.05)
|
0.006
|
FEV1% predicted |
0.93
|
(0.92,0.94)
|
< 0.001
|
0.95
|
(0.93,0.96)
|
< 0.001
|
FEV1/FVC | 0.001 | (0.001,0.001) | < 0.001 | |||
Self-reported respiratory symptoms | ||||||
Cough for more than 3 months | 37.80 | (15.55,91.87) | < 0.001 | 2.40 | (0.24,24.32) | 0.458 |
Sputum for more than 3 months | 17.78 | (7.81,40.52) | < 0.001 | 0.48 | (0.02,10.90) | 0.647 |
Dyspnea |
25.49
|
(13.68,47.49)
|
< 0.001
|
3.07
|
(1.23,7.68)
|
0.017
|
Wheezing |
7.83
|
(5.42,11.31)
|
< 0.001
|
2.90
|
(1.76,4.78)
|
< 0.001
|
Chronic bronchitis | 23.21 | (10.67,50.5) | < 0.001 | 2.76 | (0.07,109.05) | 0.588 |
Comparison of baseline characteristics, medical utilization, and costs between PRISm patients with and without medically diagnosed COPD
PRISm with medically diagnosed COPD | PRISm without medically diagnosed COPD | P-value | |
---|---|---|---|
Age | 70.06 ± 7.48 | 55.21 ± 10.49 | < 0.001 |
Male, n (%) | 16 (100.0) | 270 (90.9) | – |
Height (cm) | 162.95 ± 6.9 | 167.0 ± 6.89 | 0.023 |
Weight (kg) | 61.58 ± 13.13 | 69.04 ± 11.41 | 0.012 |
Smoking history | |||
Current smoking, n (%) | 8 (50.0) | 185 (62.3) | 0.325 |
Pack-years | 36.63 ± 14.16 | 33.02 ± 20.62 | 0.490 |
Co-morbidity, n (%) | |||
Pulmonary tuberculosis | 1 (6.3) | 20 (6.7) | 0.940 |
Asthma | 4 (25.0) | 11 (3.7) | < 0.001 |
Lung function test | |||
FVC % predicted | 64.83 ± 10.86 | 72.96 ± 9.2 | < 0.001 |
FEV1% predicted | 69.77 ± 9.16 | 72.97 ± 6.55 | 0.188 |
FEV1/FVC | 0.76 ± 0.06 | 0.77 ± 0.06 | 0.182 |
Respiratory symptoms, n (%) | |||
Cough for more than 3 months | 0 | 2 (0.7) | – |
Sputum for more than 3 months | 0 | 2 (0.7) | – |
Dyspnea | 2 (12.5) | 1 (0.3) | < 0.001 |
Wheezing | 6 (37.5) | 31 (10.4) | 0.001 |
Chronic bronchitis | 0 | 2 (0.7) | – |
OPD visit, n (%) | 15 (93.8) | 7 (2.4) | < 0.001 |
No. of OPD visit | 8.81 ± 10.15 | 0.03 ± 0.18 | < 0.001 |
Hospitalization, n (%) | 9 (56.3) | 20 (6.7) | < 0.001 |
ER visit, n (%) | 5 (31.3) | 7 (2.4) | < 0.001 |
ICU admission, n (%) | 2 (12.5) | 4 (1.4) | 0.002 |
Total hospital visit, n (%) | 16 (100.0) | 25 (8.4) | – |
ICS, n (%) | 4 (25.0) | 1 (0.3) | < 0.001 |
ICS + LABA, n (%) | 8 (50.0) | 3 (1.0) | < 0.001 |
LAMA, n (%) | 4 (25.0) | – | – |
SAMA, n (%) | 8 (50.0) | 4 (1.4) | < 0.001 |
SABA, n (%) | 8 (50.0) | 3 (1.0) | < 0.001 |
Systemic bronchodilator, n (%) | 9 (56.3) | 2 (0.7) | < 0.001 |
Methylxanthine, n (%) | 11 (68.8) | 6 (2.0) | < 0.001 |
Total prescribed medication, n (%) | 16 (100.0) | 10 (3.4) | – |
Hospitalization medical Cost (for 3 years) (USD) | 3647.51 ± 4773.55 | 223.58 ± 1535.45 | 0.012 |
Total | 16 | 297 |
Significant factors for COPD diagnosis in PRISm
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
OR | 95% CI | P-value | OR | 95% CI | P-value | |
Age (years)
|
1.14
|
(1.08, 1.21)
|
< 0.001
|
1.14
|
(1.05, 1.24)
|
0.002
|
Male | ||||||
Height (cm) | 0.93 | (0.87, 0.99) | 0.025 | 1.03 | (0.92, 1.16) | 0.564 |
Weight (kg) | 0.94 | (0.9, 0.99) | 0.013 | 0.95 | (0.89, 1.02) | 0.153 |
Smoking history | ||||||
Current smoking | 0.61 | (0.22, 1.66) | 0.329 | |||
Pack-years | 1.01 | (0.99, 1.03) | 0.490 | |||
Co-morbidity | ||||||
Pulmonary tuberculosis | 0.92 | (0.12, 7.35) | 0.940 | |||
Asthma | 8.67 | (2.41, 31.23) | 0.001 | 5.87 | (0.94, 36.56) | 0.058 |
Lung function test | ||||||
FVC % predicted | 0.93 | (0.89, 0.97) | 0.001 | 1.01 | (0.95, 1.09) | 0.694 |
FEV1% predicted | 0.95 | (0.9, 1.01) | 0.071 | |||
FEV1/FVC | 0.001 | (0.001, 35.7) | 0.183 | |||
Self-reported respiratory symptoms | ||||||
Cough for more than 3 months | ||||||
Sputum for more than 3 months | ||||||
Dyspnea | 42.29 | (3.61, 494.74) | 0.003 | 8.88 | (0.65, 121.7) | 0.102 |
Wheezing |
5.15
|
(1.75, 15.14)
|
0.003
|
4.56
|
(1.08, 19.35)
|
0.040
|
Chronic bronchitis |