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Asthma, airflow limitation and mortality risk in the general population

Shuang Huang, Monica M. Vasquez, Marilyn Halonen, Fernando D. Martinez, Stefano Guerra
European Respiratory Journal 2015 45: 338-346; DOI: 10.1183/09031936.00108514
Shuang Huang
1Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
2Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Monica M. Vasquez
1Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
2Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Marilyn Halonen
1Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
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Fernando D. Martinez
1Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
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Stefano Guerra
1Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
3CREAL Centre, CIBERESP, Universitat Pompeu Fabra, Barcelona, Spain
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    FIGURE 1

    Survival curves for mortality by chronic obstructive pulmonary disease across the four airflow limitation (AL)/asthma groups based on Cox proportional hazards models adjusted for sex, age, body mass index, education, smoking status and pack-years. a) Survival curves for the four groups based on airflow limitation defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <70%. b) Survival curves for the four groups based on airflow limitation defined as FEV1/FVC less than the lower limit of normal.

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  • TABLE 1 Baseline characteristics of participants across the four groups of airflow limitation (AL)# and asthma
    TotalAL−/asthma−AL−/asthma+AL+/asthma−AL+/asthma+p-value¶
    Subjects2121 (100)1645 (78)165 (8)237 (11)74 (3)
    Males925 (44)692 (42)66 (40)124 (52)43 (58)0.001
    Age years50±1849±1846±1860±1559±14<0.001
    BMI+0.001
     Normal 18.5–25 kg·m−21140 (56)902 (57)76 (48)129 (57)33 (45)
     Underweight <18.5 kg·m−260 (3)42 (3)1 (1)14 (6)3 (4)
     Overweight 25–30 kg·m−2694 (34)532 (33)60 (38)69 (31)33 (45)
     Obese ⩾30 kg·m−2153 (7)114 (7)21 (13)14 (6)4 (5)
    Education for >12 years913 (43)733 (45)78 (47)78 (33)24 (32)0.001
    Smoking status§<0.001
     Never-smoker868 (41)737 (45)64 (39)45 (19)22 (30)
     Former smoker519 (24)357 (22)45 (27)85 (36)32 (43)
     Current smoker733 (35)550 (33)56 (34)107 (45)20 (27)
    Pack-yearsƒ26±2423±2121±2240±2839±29<0.001
    FEV1 % predicted93±2098±1789±1773±2259±24<0.001
    Positive skin-prick tests##744 (36)552 (34)101 (64)61 (26)30 (43)<0.001
    Eosinophilia¶¶135 (8)86 (7)18 (14)17 (9)14 (23)<0.001
    IgE IU·mL−1++28 (26–30)24 (22–26)86 (66–111)27 (21–33)82 (54–125)<0.001
    Self-reported COPD§§318 (15)143 (9)57 (35)69 (30)49 (66)<0.001
    Deceased by January 1, 20111367 (64)994 (60)97 (59)209 (88)67 (91)<0.001
    • Data are presented as n (%), mean±sd or geometric mean (95% confidence interval), unless otherwise stated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; COPD: chronic obstructive pulmonary disease. #: defined as FEV1/forced vital capacity <70%; ¶: p-values are from ANOVA for continuous variables or Pearson Chi-squared test for categorical variables across the four groups; +: n=2047; §: n=2120; ƒ: only calculated among 1250 smokers; ##: n=2084; ¶¶: n=1600; ++: n=1903; §§: defined as a self-report of having been seen by a doctor for chronic bronchitis and/or emphysema (n=2111).

  • TABLE 2 Baseline characteristics of participants across the four groups of airflow limitation (AL)# and asthma
    TotalAL−/asthma−AL−/asthma+AL+/asthma−AL+/asthma+p-value¶
    Subjects2121 (100)1667 (79)163 (8)215 (10)76 (4)
    Males925 (44)717 (43)67 (41)99 (46)42 (55)0.146
    Age years50±1849±1848±1854±1855±17<0.001
    BMI+<0.001
     Normal 18.5–25 kg·m−21140 (56)905 (56)72 (46)126 (63)37 (49)
     Underweight <18.5 kg·m−260 (3)42 (3)1 (1)14 (7)3 (4)
     Overweight 25–30 kg·m−2694 (34)551 (34)66 (42)50 (25)27 (36)
     Obese ⩾30 kg·m−2153 (7)117 (7)17 (11)11 (5)8 (11)
    Education for >12 years913 (43)738 (44)73 (45)73 (34)29 (38)0.027
    Smoking status§<0.001
     Never-smoker868 (41)746 (45)65 (40)36 (17)21 (28)
     Former smoker519 (24)374 (22)46 (28)68 (32)31 (41)
     Current smoker733 (35)546 (33)52 (32)111 (52)24 (32)
    Pack-yearsƒ26±2424±2224±2335±2833±29<0.001
    FEV1 % predicted93±2098±1789±1772±2260±24<0.001
    Positive skin-prick tests##744 (36)544 (33)99 (63)69 (32)32 (44)<0.001
    Eosinophilia¶¶135 (8)87 (7)17 (14)16 (10)15 (24)<0.001
    IgE IU·mL−1++28 (26–30)23 (21–25)83 (64–108)30 (24–38)87 (58–132)<0.001
    Self-reported COPD§§318 (15)146 (9)55 (34)66 (31)51 (67)<0.001
    Deceased by January 1, 20111367 (64)1037 (62)103 (63)166 (77)61 (80)<0.001
    • Data are presented as n (%), mean±sd or geometric mean (95% confidence interval), unless otherwise stated. BMI: body mass index; FEV1: forced expiratory volume in 1 s; COPD: chronic obstructive pulmonary disease. #: defined as FEV1/forced vital capacity less than the lower limit of normal; ¶: p-values are from ANOVA for continuous variables or Pearson Chi-squared test for categorical variables across the four groups; +: n=2047; §: n=2120; ƒ: only calculated among 1250 smokers; ##: n=2084; ¶¶: n=1600; ++: n=1903; §§: defined as a self-report of having been seen by a doctor for chronic bronchitis and/or emphysema (n=2111).

  • TABLE 3 Cox proportional hazards models for all-cause mortality#
    Model 1¶Model 2+
    Sex
     Male11
     Female0.73 (0.65–0.82)***0.73 (0.65–0.82)***
    Age at baseline years1.11 (1.10–1.11)***1.11 (1.10–1.12)***
    BMI
     Normal 18.5–25 kg·m−211
     Underweight <18.5 kg·m−21.71 (1.17–2.48)*1.69 (1.16–2.47)*
     Overweight 25–30 kg·m−20.91 (0.81–1.02)0.91 (0.81–1.02)
     Obese ⩾30 kg·m−21.32 (1.09–1.59)*1.31 (1.08–1.58)*
    Education for >12 years0.90 (0.81–1.00)*0.90 (0.81–1.00)*
    Smoking status
     Never-smoker11
     Former smoker0.89 (0.76–1.05)0.89 (0.76–1.04)
     Current smoker1.42 (1.21–1.67)***1.41 (1.20–1.66)***
    Pack-years1.01 (1.01–1.01)***1.01 (1.01–1.01)***
    AL/asthma groups
     AL−/asthma−11
     AL−/asthma+1.09 (0.89–1.34)1.08 (0.89–1.31)
     AL+/asthma−1.34 (1.14–1.57)***1.37 (1.14–1.63)*
     AL+/asthma+2.14 (1.64–2.79)***2.35 (1.77–3.11)***
    • Data are presented as hazard ratio (95% confidence interval). BMI: body mass index; AL: airflow limitation. #: n=2118; ¶: based on the definition of airflow limitation as forced expiratory volume in 1s (FEV1)/forced vital capacity (FVC) <70%; +: based on the definition of airflow limitation as FEV1/FVC less than the lower limit of normal. *: p<0.05; ***: p<0.001.

  • TABLE 4 Cox proportional hazards models for all-cause mortality among the 310 subjects with airflow limitation (AL) at baseline#
    Model 1¶Model 2+
    Sex
     Male11
     Female0.66 (0.50–0.87)*0.72 (0.55–0.95)*
    Age at baseline years1.10 (1.08–1.12)***1.10 (1.09–1.12)***
    BMI
     Normal 18.5–25 kg·m−211
     Underweight <18.5 kg·m−22.29 (1.29–4.06)*2.27 (1.27–4.07)*
     Overweight 25–30 kg·m−20.71 (0.54–0.93)*0.79 (0.61–1.03)
     Obese ⩾30 kg·m−21.09 (0.61–1.96)1.04 (0.56–1.93)
    Education for >12 years0.76 (0.59–0.98)*0.80 (0.62–1.03)
    Smoking status
     Never-smoker11
     Former smoker0.99 (0.66–1.48)1.01 (0.67–1.52)
     Current smoker1.27 (0.83–1.92)1.29 (0.86–1.94)
    Pack-years1.01 (1.00–1.02)***1.01 (1.00–1.01)*
    AL/asthma groups
     AL+/asthma-11
     AL+/asthma+1.58 (1.17–2.12)***1.27 (0.94–1.73)
    FEV1 % predicted at baseline0.98 (0.98–0.99)***
    • Data are presented as hazard ratio (95% confidence interval). BMI: body mass index; FEV1: forced expiratory volume in 1 s. #: defined as FEV1/forced vital capacity <70%; ¶: included sex, age, BMI, education, smoking status, pack-years and asthma; +: further adjusted for FEV1% predicted. *: p<0.05; ***: p<0.001.

  • TABLE 5 Cox proportional hazards models for all-cause mortality among the 291 subjects with airflow limitation (AL) at baseline#
    Model 1¶Model 2+
    Sex
     Male11
     Female0.73 (0.54–0.99)*0.81 (0.60–1.10)
    Age at baseline years1.10 (1.08–1.11)***1.10 (1.08–1.11)***
    BMI
     Normal 18.5–25 kg·m−211
     Underweight <18.5 kg·m−22.48 (1.29–4.74)*2.46 (1.30–4.65)*
     Overweight 25–30 kg·m−20.73 (0.53–1.00)*0.80 (0.60–1.09)
     Obese ⩾30 kg·m−20.96 (0.50–1.83)0.93 (0.47–1.84)
    Education for >12 years0.70 (0.53–0.92)*0.71 (0.53–0.94)*
    Smoking status
     Never-smoker11
     Former smoker1.10 (0.70–1.71)1.15 (0.73–1.83)
     Current smoker1.22 (0.77–1.94)1.36 (0.85–2.20)
    Pack-years1.01 (1.00–1.02)*1.01 (1.00–1.02)*
    AL/asthma groups
     AL+/asthma−11
     AL+/asthma+1.64 (1.18–2.29)*1.30 (0.91–1.84)
    FEV1 % predicted at baseline0.98 (0.97–0.99)***
    • Data are presented as hazard ratio (95% confidence interval). BMI: body mass index; FEV1: forced expiratory volume in 1 s. #: defined as FEV1/forced vital capacity less than the lower limit of normal; ¶: included sex, age, BMI, education, smoking status, pack-years and asthma; +: further adjusted for FEV1% predicted. *: p<0.05; ***: p<0.001.

Additional Files

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    Files in this Data Supplement:

    • S. Guerra
    • M. Halonen
    • F.D. Martinez
    • M.M. Vasquez
  • Supplementary material

    Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

    Files in this Data Supplement:

    • supplementary tables - Tables E1-E4
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Asthma, airflow limitation and mortality risk in the general population
Shuang Huang, Monica M. Vasquez, Marilyn Halonen, Fernando D. Martinez, Stefano Guerra
European Respiratory Journal Feb 2015, 45 (2) 338-346; DOI: 10.1183/09031936.00108514

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Asthma, airflow limitation and mortality risk in the general population
Shuang Huang, Monica M. Vasquez, Marilyn Halonen, Fernando D. Martinez, Stefano Guerra
European Respiratory Journal Feb 2015, 45 (2) 338-346; DOI: 10.1183/09031936.00108514
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