American Journal of Epidemiology Vol. 147, No. 11: 1011-1018
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Pulmonary Function Levels as Predictors of Mortality in a National Sample of US Adults
Department of Epidemiology and Environmental Health, Harvard School of Public Health, and Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School Boston, MA.
Reprint requests to Dr. M. Neas, Department of Environmental Health, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115.
Single breath pulmonary diffusing capacity for carbon monoxide (DLCO) was examined as a predictor of all-cause mortality among 4,333 subjects who were aged 25–74 years at baseline in the First National Health and Nutrition Examination Survey (NHANES I) conducted from 1971 to 1975. The relation of the percentage of predicted DLCO to all-cause mortality was examined in a Cox proportional hazard model that included age, sex, race, current smoking status, systolic blood pressure, serum cholesterol, alcohol consumption, body mass index, percentage of predicted forced vital capacity (FVC), and the ratio of forced expiratory volume at 1 second (FEV1) to FVC. Mortality had a linear association with the percentage of predicted FVC (rate ratio (RR) = 1.12, 95% confidence interval (Cl) 1.08–1.17, for a 10% decrement) and a significantly nonlinear association with the percentage of predicted DLCO with an adverse effect that was clearly evident for levels below 85% of those predicted (RR =1.24, 95% Cl 1.12–1.37 for a 10% decrement). The relative hazard for the percentage of predicted DLCO below 85% was not modified by sex, smoking status, or exclusion of subjects with clinical respiratory disease on the initial examination. This association with the percentage of predicted DLCO was present among 3,005 subjects with FEV1 levels above 90% of those predicted. Thus, pulmonary diffusing capacity below 85% of predicted levels is a significant predictor of the all-cause mortality rate within the general US population independent of standard spirometry measures and even in the absence of apparent clinical respiratory disease. Am J Epidemiol 1998;147:1011-18.
adult; mortality; pulmonary diffusing capacity; respiratory function tests
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