title: COPD in a nationally representative sample: sociodemographic factors and co-morbidity, diagnosis method, and healthcare utilization.
abstract: BACKGROUND
  In 2011, the Centers for Disease Control and Prevention for the first time ever collected nationally representative prevalence data on chronic obstructive pulmonary disease (COPD), spirometry diagnosis, and healthcare utilization factors related to COPD. This research reports on that data and describes characteristics of adults with COPD who reported diagnosis by spirometry compared to those who did not report diagnosis by spirometry. Variables examined included basic elements of healthcare utilization such as emergency room visits, hospitalization or personal physician utilization.
  
  
  METHODS
  This is a cross-sectional study using novel data from the 2011 Behavioral Risk Factor Surveillance System COPD Module. Weighted multivariable logistic regression examined factors associated with (n = 13,484) and without spirometry (n = 3,131).
  
  
  RESULTS
  Spirometry to diagnose COPD was reported by 78% of adults and increased with age. In multivariable modeling, spirometry was more likely in: Black, non-Hispanic compared to white non-Hispanic; current and former compared to never smokers; adults with co-morbidity including asthma, depression, and cardiovascular disease; adults with a doctor; and those who had been to emergency room/hospital for COPD. Those less likely to receive a spirometry were: Hispanic and reported exercise in the past 30 days.
  
  
  CONCLUSIONS
  This study identified that adults diagnosed with COPD without a spirometry tended to be Hispanic, younger, healthier, and had less utilization of medical resources. This study is a first step in understanding the potential impact of COPD diagnosis made without spirometry.
authors.affiliation: 1Department of Epidemiology and Biostatistics, Kent State University , Kent, OH , USA.
authors.forename: Dana S
authors.initials: DS
authors.lastname: Mowls
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Cheruvu
authors.forename: Robert
authors.initials: R
authors.lastname: Schilz
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Zullo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D062486:Public Health Surveillance; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D013147:Spirometry / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Behavioral Risk Factor Surveillance System; breathing test; race/ethnicity; spirometry