1. Prediction of COPD risk accounting for time-varying smoking exposures
- Author
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Rafael Meza, Jihyoun Jeon, Douglas A. Arenberg, David T. Levy, and Joanne T. Chang
- Subjects
Male ,Pulmonology ,Epidemiology ,Health Care Providers ,Social Sciences ,Nurses ,Pulmonary function testing ,Pulmonary Disease, Chronic Obstructive ,Habits ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Risk Factors ,Medicine and Health Sciences ,Smoking Habits ,Psychology ,Medicine ,Medical Personnel ,030212 general & internal medicine ,Cause of death ,COPD ,Multidisciplinary ,Cancer Risk Factors ,Incidence (epidemiology) ,Smoking ,Statistics ,Middle Aged ,Professions ,Oncology ,Physical Sciences ,Female ,Cancer Epidemiology ,Research Article ,Adult ,medicine.medical_specialty ,Chronic Obstructive Pulmonary Disease ,Science ,Research and Analysis Methods ,Models, Biological ,03 medical and health sciences ,Predictive Value of Tests ,Humans ,Statistical Methods ,Aged ,Asthma ,Behavior ,Receiver operating characteristic ,business.industry ,Proportional hazards model ,Biology and Life Sciences ,medicine.disease ,Health Care ,030228 respiratory system ,Medical Risk Factors ,People and Places ,Population Groupings ,business ,Mathematics ,Follow-Up Studies ,Forecasting ,Demography - Abstract
Rationale Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States. Studies have primarily assessed the relationship between smoking on COPD risk focusing on summary measures, like smoking status. Objective Develop a COPD risk prediction model incorporating individual time-varying smoking exposures. Methods The Nurses’ Health Study (N = 86,711) and the Health Professionals Follow-up Study (N = 39,817) data was used to develop a COPD risk prediction model. Data was randomly split in 50–50 samples for model building and validation. Cox regression with time-varying covariates was used to assess the association between smoking duration, intensity and year-since-quit and self-reported COPD diagnosis incidence. We evaluated the model calibration as well as discriminatory accuracy via the Area Under the receiver operating characteristic Curve (AUC). We computed 6-year risk of COPD incidence given various individual smoking scenarios. Results Smoking duration, year-since-quit (if former smokers), sex, and interaction of sex and smoking duration are significantly associated with the incidence of diagnosed COPD. The model that incorporated time-varying smoking variables yielded higher AUCs compared to models using only pack-years. The AUCs for the model were 0.80 (95% CI: 0.74–0.86) and 0.73 (95% CI: 0.70–0.77) for males and females, respectively. Conclusions Utilizing detailed smoking pattern information, the model predicts COPD risk with better accuracy than models based on only smoking summary measures. It might serve as a tool for early detection programs by identifying individuals at high-risk for COPD.
- Published
- 2021
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