Accuracy of electronic health record data for the diagnosis of chronic obstructive pulmonary disease in persons living with HIV and uninfected persons

Pharmacoepidemiol Drug Saf. 2019 Feb;28(2):140-147. doi: 10.1002/pds.4567. Epub 2018 Jun 20.


Purpose: No prior studies have addressed the performance of electronic health record (EHR) data to diagnose chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWH), in whom COPD could be more likely to be underdiagnosed or misdiagnosed, given the higher frequency of respiratory symptoms and smoking compared with HIV-uninfected (uninfected) persons.

Methods: We determined whether EHR data could improve accuracy of ICD-9 codes to define COPD when compared with spirometry in PLWH vs uninfected, and quantified level of discrimination using the area under the receiver-operating curve (AUC). The development cohort consisted of 350 participants who completed research spirometry in the Examinations of HIV Associated Lung Emphysema (EXHALE) study, a pulmonary substudy of the Veterans Aging Cohort Study. Results were externally validated in 294 PLWH who performed spirometry for clinical indications from the University of Washington (UW) site of the Centers for AIDS Research Network of Integrated Clinical Systems cohort.

Results: ICD-9 codes performed similarly by HIV status, but alone were poor at discriminating cases from non-cases of COPD when compared with spirometry (AUC 0.633 in EXHALE; 0.651 in the UW cohort). However, algorithms that combined ICD-9 codes with other clinical variables available in the EHR-age, smoking, and COPD inhalers-improved discrimination and performed similarly in EXHALE (AUC 0.771) and UW (AUC 0.734).

Conclusions: These data support that EHR data in combination with ICD-9 codes have moderately good accuracy to identify COPD when spirometry data are not available, and perform similarly in PLWH and uninfected individuals.

Keywords: HIV; area under curve; chronic obstructive pulmonary disease; electronic health records; pharmacoepidemiology; pulmonary disease; smoking.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Administration, Inhalation
  • Age Factors
  • Algorithms
  • Bronchodilator Agents / therapeutic use*
  • Cohort Studies
  • Data Accuracy*
  • Data Interpretation, Statistical
  • Drug Prescriptions / statistics & numerical data
  • Electronic Health Records / statistics & numerical data*
  • Female
  • HIV Infections / complications*
  • HIV Infections / epidemiology
  • Humans
  • International Classification of Diseases
  • Logistic Models
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers / statistics & numerical data
  • Prevalence
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / etiology
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Spirometry / statistics & numerical data


  • Bronchodilator Agents