title: Agreement between obstructive airways disease diagnoses from self-report questionnaires and medical records.
abstract: OBJECTIVE
  To evaluate agreement between self-reported obstructive airways disease (OAD) diagnoses of asthma, bronchitis, and chronic obstructive pulmonary disease (COPD)/emphysema obtained from the New York City Fire Department (FDNY) monitoring questionnaires with physician diagnoses from FDNY medical records.
  
  
  METHODS
  We measured sensitivity, specificity, and agreement between self-report and physician OAD diagnoses in FDNY members enrolled in the World Trade Center (WTC) monitoring program who completed a questionnaire between 8/2005-1/2012. Using logistic models, we identified characteristics of those who self-report a physician diagnosis that is also reported by FDNY physicians.
  
  
  RESULTS
  20.3% of the study population (N=14,615) self-reported OAD, while 15.1% received FDNY physician OAD diagnoses. Self-reported asthma had the highest sensitivity (68.7%) and overall agreement (91.9%) between sources. Non-asthma OAD had the lowest sensitivity (32.1%). Multivariate analyses showed that among those with an OAD diagnosis from FDNY medical records, inhaler use (OR=4.90, 95% CI=3.84-6.26) and respiratory symptoms (OR=1.55 [95% CI=1.25-1.92]-1.77 [95% CI=1.37-2.27]) were associated with self-reported OAD diagnoses.
  
  
  CONCLUSIONS
  Among participants in the WTC monitoring program, sensitivity for self-reported OAD diagnoses ranges from good to poor and improves by considering inhaler use. These findings highlight the need for improved patient communication and education, especially for bronchitis or COPD/emphysema.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Weakley
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Fen
authors.initials: F
authors.lastname: Ye
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hall
authors.forename: Kerry
authors.initials: K
authors.lastname: Kelly
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D004784:Environmental Monitoring; D005260:Female; D061388:Firefighters / Q000706:statistics & numerical data*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009519:New York City; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D015397:Program Evaluation; D057566:Self Report; D012680:Sensitivity and Specificity; D047851:September 11 Terrorist Attacks / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires