Identifying COPD in routinely collected electronic health records: a systematic scoping review

Abstract

Although routinely collected electronic health records (EHR) are widely used to examine outcomes related to chronic obstructive pulmonary disease (COPD), consensus regarding the identification of cases from electronic healthcare databases is lacking. We systematically examine and summarise approaches from the recent literature.MEDLINE via EBSCOhost was searched for COPD-related studies using EHR published from January 1, 2018 to November 30, 2019. Data were extracted relating to the case definition of COPD and determination of COPD severity and phenotypes.From 185 eligible studies, we found widespread variation in the definitions used to identify people with COPD in terms of code sets used (with 20 different code sets in use based on the ICD-10 classification alone) and requirement of additional criteria (relating to age (n=139), medication (n=31), multiplicity of events (n=21), spirometry (n=19) and smoking status (n=9)). Only 7 studies used a case definition which had been validated against a reference standard in the same dataset. Various proxies of disease severity were used since spirometry results and patient-reported outcomes were not often available.To enable the research community to draw reliable insights from electronic health records and aid comparability between studies, clear reporting and greater consistency of the definitions used to identify COPD and related outcome measures is key.

Use and persistence of single and multiple inhaler triple therapy prescribed for patients with COPD in France: a retrospective study on THIN database (OPTI study)

“…The patient characteristics were also in line with a study carried out using the UK primary care database, the Clinical Practice Research Datalink 36. The codes used to identifyD patients with COPD are consistent with other European database studies 25–27. Moreover, the sensitivity analyses provided no evidence that chronic bronchitis or asthma affected the finding that SITT was observed to have a greater persistence than MITT.…”

“…Patients were eligible for this study if they initiated a new triple therapy regimen (LABA, LAMA and ICS) in the study inclusion period comprising 1 July 2017 until 31 December 2019 and had a diagnosis of COPD or chronic bronchitis at or prior to the initiation of their triple therapy. Inclusion of patients coded with chronic bronchitis increases the sensitivity of the case definition and is consistent with other European database studies 25–27. Other respiratory comorbidities such as asthma or bronchiectasis when associated with COPD or chronic bronchitis were not excluded as they are common COPD comorbidities 28.…”

“…36 The codes used to identifyD patients with COPD are consistent with other European database studies. [25][26][27] Moreover, the sensitivity analyses provided no evidence that chronic bronchitis or asthma affected the finding that SITT was observed to have a greater persistence than MITT. The results of this study highlight the high disease burden of patients with COPD who require triple therapy, with frequent comorbidities comprising hypertension, depression, diabetes and asthma.…”

“…Inclusion of patients coded with chronic bronchitis increases the sensitivity of the case definition and is consistent with other European database studies. [25][26][27] Other respiratory comorbidities such as asthma or bronchiectasis when associated with COPD or chronic bronchitis were not excluded as they are common COPD comorbidities. 28 Treatments were recorded from pharmacy dispensation data.…”

Chronic obstructive pulmonary disease mortality trends in Spain, 1980-2020

“…First, the validity of the COPD codes recorded on death certificates is unknown. Although different authors have used various approaches to identify COPD cases in databases [ 22 ], the use of death certificate codes remains the most common method, thus making our data easier to compare with previous initiatives. Second, the study period spanned several ICD transitions, and may therefore have been subject to sudden artificial changes in mortality rates, such as when the change from ICD-9 to ICD-10 took place in Spain in 1999.…”