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Measuring the prevalence of asthma and COPD by self-report and from routine general practice care: what's the difference?

Linden, M.W. van der, Schellevis, F.G., Mahangoo, A.D., Raat, H. Measuring the prevalence of asthma and COPD by self-report and from routine general practice care: what's the difference? European Journal of Public Health: 2003, 13(4 vsup) 99. Abstract. 11th Annual Eupha Meeting 'Globalisation and Health in Europe: Harmonising Public Health Practices'. Rome, Italy, 20-22 November 2003.
Background: Prevalence rates of chronic diseases are important indicators for the disease burden of a population and for planning health services. Prevalences can be measured using different methods, each with advantages and disadvantages. Aim: To determine the prevalence of asthma and chronic obstructive pulmonary disease (COPD) using data from a health interview survey and general practice medical records in the same population and to explain existing differences. Methods: The second Dutch National Survey of General Practice included a health interview survey carried out in 2001 among a 5% random sample of the practice population of the 195 participating general practitioners (GPs) with questions about the presence of asthma or COPD (N=12.699 respondents; response rate=65%). The GPs recorded and coded morbidity data during all consultations with their patients during 12 months. Comparisons on the presence of asthma or COPD were made on individual level. Explanatory variables included age, sex, ethnic origin, health insurance, educational level, urbanisation level, smoking, and other health problems, and were used in multivariate logistic regression analyses. Results: The prevalence of self-reported asthma or COPD was 9.5% and on the basis of the medical records 4.9% (Cohen’s kappa=0.4; observed agreement 92%). Patients with asthma or COPD only by self-report usually showed to have other respiratory problems in their medical record. Patients with asthma or COPD only in their medical record were relatively older and lived with people who smoked. Other explanatory variables did not show independent significant effects. Conclusions: Two methods for measuring prevalence of asthma or COPD provide different results: when compared to medical records, self-reported prevalence shows an overestimation in people who suffer from other respiratory diseases and an underestimation in elderly who live in a smoky environment. These differences should be taken into account when choosing a method to measure prevalence rates. (aut. ref.)
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