[Analysis on differences in healthcare-seeking behavior in patients with chronic obstructive pulmonary disease...

Objective: To compare demographic characteristics and healthcare-seeking behaviors of patients with chronic obstructive pulmonary disease (COPD) identified through community-based pulmonary function test (PFT) screening and symptom-prompted diagnosis via a regional health information platform in Songjiang district, Shanghai. Methods: A total of 2 038 COPD patients aged ≥40 years were included from a suburban population-based cohort and a regional healthcare information platform, including 216 screening diagnosed patients and 1 822 symptom-prompted diagnosed patients (the patients diagnosed in outpatients). Demographic characteristics and outpatient visits, hospitalizations, and respiratory-related visits during follow-up were compared. Associations between case-finding pathways and healthcare-seeking behaviors were analyzed by using a hurdle negative binomial regression model. Results: Compared with the screening-diagnosed group, the symptom-prompted diagnosed patients had higher proportion of women, lower prevalence of smoking and alcohol consumption, higher prevalence of respiratory comorbidities, and higher severity grade by Global Initiative for Chronic Obstructive Lung Disease. Compared with the screening diagnosed group, the symptom-prompted diagnosed group had higher risk for outpatient visits, respiratory illness-related outpatient visits, hospitalizations, and respiratory illness-related hospitalizations, with ORs of 17.28 (95%CI: 1.46-204.32), 13.30 (95%CI: 8.28-21.36), 2.26 (95%CI: 1.66-3.08), and 4.07 (95%CI: 2.10-8.31), respectively. In addition, the outpatient visit density, respiratory illness-related outpatient visit density, and hospitalization density were higher in the symptom-prompted diagnosed group than in screening diagnosed group, with RRs of 2.00 (95%CI: 1.80-2.22), 2.84 (95%CI: 2.35-3.43), and 1.52 (95%CI: 1.14-2.02) , respectively. Conclusions: Healthcare-seeking behaviors differed significantly by COPD case- finding pathway. The symptom-prompted diagnosed patients showed higher healthcare-seeking intensity, whereas community-based PFT screening was more likely to identify early-stage patients with lower healthcare dependence, supporting pathway-specific stratified management of COPD.