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Outcomes of the previously described definitions of diagnosis of COPD and of the severity of COPD were compared with both observers, and agreement was quantified by the proportion of simple agreement and the Kappa index, an estimator that takes into account agreement that occurs by chance.
Agreement between the diagnosis of COPD and the diagnosis by the two independent observers was 88% and 95% and produced kappa estimates of 0.76 and 0.90, respectively.
From 1990 to 1997 the annual prevalence rates of physician diagnosed COPD in women rose continuously from 0.80% (95% CI 0.75 to 0.83) to 1.36% (95% CI 1.34 to 1.39), (p for trend Chronic obstructive pulmonary disease (COPD) is a chronic disorder responsible for a major burden in health care.
The World Health Report of 1998 states that 2.9 million adults die each year of COPD, and it ranks COPD as the fifth cause of mortality worldwide (just after ischaemic heart disease, cerebrovascular disease, acute lower respiratory infection, and tuberculosis) and as the fifth most prevalent disease (after iron deficiency anaemia, neck and back disorders, goitre and hypertensive disease) for 1997.1Prevalence and mortality figures are expected to increase early in the 21st century, particularly in developing countries such as China,2 but the burden of COPD in developed countries is expected to remain substantial.
The natural history of COPD in the community is largely unknown, particularly in women.
Few mortality studies and use of health services studies have been performed to date in women.
As of 1998, 525 practices have participated with a total population of 3.4 million patients—that is, 6.4% of the total population of England and Wales—and 105 practices have been supplying data for four years or more.
Most of the published reports of COPD that use an automated database come from a single source, the Saskatchewan study,3 in Canada.
Further, one of the largest cohorts of COPD patients identified is the Barcelona cohort in Spain.4 Both databases have been proved to be valid tools, but they may not represent the UK experience and they have a relatively small number of female patients.
When a patient dies the date of death is recorded in the computerised patient medical records.
The GPRD system uses the OXMIS coding system which is loosely based on the ICD-9 coding system: the first three digits of the OXMIS number corresponds, in most cases, to the first three digits of the ICD-9 codes.