@article{Whittaker:2021:10.2147/POR.S319965,
author = {Whittaker, H and Kiddle, S and Quint, J},
doi = {10.2147/POR.S319965},
journal = {Pragmatic and Observational Research},
pages = {119--130},
title = {Challenges and pitfalls of using repeat spirometry recordings in routine primary care data to measure FEV1 decline in a COPD population},
url = {http://dx.doi.org/10.2147/POR.S319965},
volume = {2021},
year = {2021}
}

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TY  - JOUR
AB  - BackgroundElectronic healthcare records (EHR) are increasingly used for epidemiological studies but are often viewed as lacking quality compared to randomised control trials and prospective cohorts. Studies of patients with chronic obstructive pulmonary disease (COPD) often use rate of forced expiratory volume in 1 second (FEV1) decline as an outcome however, its definition and robustness in EHR has not be investigated. We aimed to investigate how rate of FEV1 decline differs by the criteria used in an EHR database.MethodsClinical Practice Research Datalink and Hospital Episode Statistics were used. Patient populations were defined using 8 sets of criteria around repeated FEV1 measurements. At a minimum, patients had a diagnosis of COPD, were ≥35 years old, were current or ex-smokers, and had data recorded from 2004. FEV1 measurements recorded during follow-up were identified. Thereafter, eight populations were defined based on criteria around: i) the exclusion of patients or individual measurements with potential measurement error; ii) minimum number of FEV1 measurements; iii) minimum time interval between measurements; iv) specific timing of measurements; v) minimum follow-up time; and vi) the use of linked data. For each population, rate of FEV1 decline was estimated using mixed linear regression. ResultsFor 7/8 patient populations, rates of FEV1 decline (age and sex adjusted) were similar and ranged from -18.7ml/year (95%CI -19.2 to -18.2) to -16.5ml/year (95%CI -17.3 to -15.7). Rates of FEV1 decline in populations that excluded patients with potential measurement error ranged from -79.4ml/year (95%CI -80.7 to -78.2) to -46.8ml/year (95%CI -47.6 to -46.0). ConclusionsFEV1 decline remained similar in a COPD population regardless of number of FEV1 measurements, time intervals between measurements, follow-up period, exclusion of specific FEV1 measurements, and linkage to HES. However, exclusion of individuals with questionable data led to selection bias and fast
AU  - Whittaker,H
AU  - Kiddle,S
AU  - Quint,J
DO  - 10.2147/POR.S319965
EP  - 130
PY  - 2021///
SN  - 1179-7266
SP  - 119
TI  - Challenges and pitfalls of using repeat spirometry recordings in routine primary care data to measure FEV1 decline in a COPD population
T2  - Pragmatic and Observational Research
UR  - http://dx.doi.org/10.2147/POR.S319965
UR  - https://www.dovepress.com/challenges-and-pitfalls-of-using-repeat-spirometry-recordings-in-routi-peer-reviewed-fulltext-article-POR
UR  - http://hdl.handle.net/10044/1/90614
VL  - 2021
ER  - 

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