Prevalence, diagnostic accuracy, and healthcare utilization patterns in patients with COPD in primary healthcare: a population-based study

Abstract

Underdiagnosis and overdiagnosis commonly occur in Chronic Obstructive Pulmonary Disease (COPD) patients. We assessed diagnostic accuracy, clinical characteristics, healthcare utilization, and care plan registration for patients undergoing primary care. We conducted a cross-sectional, population-based study using a health record registry from four primary healthcare centers in Catalonia (Spain) for patients aged ≥15 years. The variables included sociodemographic characteristics, dyspnea, comorbidities, spirometry results, treatments, and healthcare use. Logistic regression models were used to analyze differences between patients with and without airflow limitation, and ordinal logistic regression models were used to examine the association between disease severity and healthcare use. Among the 2610 patients, 54% had spirometry data, 29.5% had confirmed airflow obstruction, and 24% were overdiagnosed according to the GOLD criteria. Patients without airflow obstruction were younger (OR: 0.98, 95% CI: 0.96-0.99) and more likely to be current smokers (OR: 1.44, 95% CI: 1.13-1.84). Airflow obstruction severity was significantly associated with increased use of emergency home ambulance use (OR: 1.7, 95% CI: 1.23-2.35), emergency department visits (OR: 1.48, 95% CI: 1.11-1.99), and hospital admission (OR: 1.8, 95% CI: 1.32-2.47), but not primary care visits and follow-up frequency. COPD is frequently overdiagnosed in primary healthcare settings. The severity of airflow obstruction is associated with increased healthcare utilization, including hospital admissions. Improved diagnostic accuracy and management may enhance COPD care and reduce healthcare costs.