Most COPD is underdiagnosed and linked to higher mortality
In over 119,000 adults, 89.2% of COPD cases were underdiagnosed, which was associated with a 1.53 hazard ratio for mortality compared to having no COPD.
The Lancet Global Health
In a prospective study of 119,252 adults aged 35 to 70 across 25 countries, researchers assessed the burden and outcomes of chronic obstructive pulmonary disease (COPD). Participants completed spirometry testing and were monitored every three years for vital status and clinical events. Airflow obstruction was present in 9.5% of participants, and 89.2% of these individuals had no prior physician diagnosis, categorizing them as having underdiagnosed COPD.
Compared with participants without COPD, underdiagnosed COPD was associated with elevated risks of death (hazard ratio 1.53), respiratory events (hazard ratio 1.97), and cardiovascular events (hazard ratio 1.20). Diagnosed COPD carried hazard ratios of 2.09 for mortality, 3.70 for respiratory events, and 1.35 for cardiovascular events. Underdiagnosis reached 90.7% in low- and middle-income countries and was associated with younger age, lower symptom burden, and higher baseline lung function.
Why it matters
Progressive airflow obstruction contributes significantly to functional loss and systemic disease as adults age. These findings indicate that the vast majority of individuals with compromised lung function remain unidentified during earlier stages when clinical interventions could alter health trajectories.
Caveats
Because this was an observational study, the reported associations between COPD diagnosis status and clinical outcomes do not prove causation. Furthermore, categorization of diagnosis relied on self-reported history of physician diagnosis alongside spirometry measurements.
The paper
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