Chest
Volume 118, Issue 3, September 2000, Pages 656-664
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Clinical Investigations
Pulmonary Function
Pulmonary Function Is a Long-term Predictor of Mortality in the General Population: 29-Year Follow-up of the Buffalo Health Study

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Study objectives

Results from several studies havedescribed a relationship between pulmonary function and both all-causeand cause-specific mortality. The purpose of this study was toinvestigate the predictive value of pulmonary function by gender after29 years of follow-up.

Design

Prospective study with29-year follow-up of the Buffalo Health Study cohort.

Participants

Randomly selected sample of 554 men and 641women, aged 20 to 89 years, from all listed households of the city of, Buffalo, NY.

Measurements and results

Baselinemeasurements were performed in 1960 to 1961. Pulmonary function wasassessed based on FEV1 expressed as the normal percentpredicted (FEV1% pred). FEV1% pred adjusted byage, body mass index, systolic BP, education, and smoking status wasinversely related to all-cause mortality in both men and women(p < 0.01). A sequential survival analysis in participants who had asurvival time of at least 5, 10, 15, 20, and 25 years after enrollmentin the study was also performed. Except for men who survived for > 25years, we observed a statistically significant negative associationbetween FEV1% pred and all-cause mortality. FEV1% pred was also inversely related to ischemic heartdisease (IHD) mortality. When participants were divided into quintilesof FEV1% pred, participants in the lowest quintile of, FEV1% pred experienced significantly higher all-causemortality compared with participants in the highest quintile of, FEV1% pred. For the entire follow-up period, the adjustedhazard ratios for all-cause mortality were 2.24 (95% confidenceinterval [CI], 1.60 to 3.13) for men and 1.81 (95% CI, 1.24 to 2.63)for women, respectively. Hazard ratios for death from IHD in the lowestquintile of FEV1% pred were 2.11 (95% CI, 1.20 to 3.71)and 1.96 (95% CI, 0.99 to 3.88) for men and women, respectively.

Conclusions

These results suggest that pulmonary functionis a long-term predictor for overall survival rates in both genders and could be used as a tool in general healthassessment.

Section snippets

Study Population

The Buffalo BP/Erie County Air Pollution-Pulmonary Function Study enrolled 2,273 men and women aged 15 to 96 years from 1960 to1961. This epidemiologic study engaged a randomly selected populationsample of the city of Buffalo, NY, and was designed initially toinvestigate factors related to hypertension and pulmonary function. Thedetails of the study design, participation, follow-up, and ascertainment of vital status have been describedelsewhere.131415 In brief, a random sample of

Results

There was no statistically significant difference in baselinevariables between the 254 participants without pulmonary functionrecords and the remaining 1,494 participants with pulmonary functiondata. Participants without pulmonary function data were less likely tobe women than men (49.8% vs 55.8%, respectively), were slightly older(45.7 vs 44.2 years, respectively), and had higher SBP (141.4 vs 139.0mm Hg, respectively) but showed similar height, education, and smokinghabits.

Baseline

Discussion

The findings of this cohort study suggest that, FEV1 is a risk factor for all-cause and for IHDmortality for a follow-up period of 29 years after adjustment for otherrisk factors. The exclusion of participants who die early duringfollow-up does not seem to alter the results. Only after the exclusionof participants who died within 25 years of follow-up does, FEV1 not predict the all-cause mortality rate inmen, although power was limited after the exclusion of this group ofparticipants, and the

Conclusion

In summary, our results extend those from previous studiesindicating that FEV1% pred is a statisticallysignificant predictor for both all-cause and IHD mortality in bothgenders in follow-up periods of 29 years. As has been pointed out by, Persson et al,11 there is an urgency to reach a betterunderstanding of the relationship of impaired pulmonary function todisease in order to undertake preventive measures. From severalstudies, we know that smoking cessation does not seem to be the onlysolution

References (36)

  • LM Neas et al.

    Pulmonary function levels as predictors of mortality in a national sample of US adults

    Am J Epidemiol

    (1998)
  • C Persson et al.

    Peak expiratory flow and risk of cardiovascular disease and death

    Am J Epidemiol

    (1986)
  • K Yano et al.

    Ten-year incidence of coronary heart disease in the Honolulu Heart Program

    Am J Epidemiol

    (1984)
  • W Winkelstein et al.

    The Erie County air pollution-pulmonary function study

    Am Rev Respir Dis

    (1962)
  • W Winkelstein

    Study of blood pressure in Buffalo, New York

    Ann N Y Acad Sci

    (1963)
  • JP Dorn et al.

    Body mass index and mortality in a general population sample of men and women: the Buffalo Health Study

    Am J Epidemiol

    (1997)
  • American Thoracic Society

    Standardization of spirometry: 1994 update

    Am J Respir Crit Care Med

    (1995)
  • RJ Knudson et al.

    Changes in the normal maximal expiratory flow-volume curve with growth and aging

    Am Rev Respir Dis

    (1983)
  • Cited by (0)

    This research was supported by the National Heart, Lung, and Blood Institute (grant No. HL5487402) and Deutsche Forschungsgemeinschaft(grant No. SCHU 1056–1/1).

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