RT Journal Article
SR Electronic
T1 Respiratory impairment and COPD hospitalisation in older persons: a competing risk analysis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 37
OP 44
DO 10.1183/09031936.00128711
VO 40
IS 1
A1 Carlos A. Vaz Fragoso
A1 John Concato
A1 Gail McAvay
A1 Peter H. Van Ness
A1 Thomas M. Gill
YR 2012
UL http://erj.ersjournals.com/content/40/1/37.abstract
AB The aim of the present study was to evaluate, among older persons, the association between respiratory impairment and hospitalisation for chronic obstructive pulmonary disease (COPD), based on spirometric Z-scores, i.e. the LMS (lambda, mu, sigma) method, and a competing risk approach. Using data on 3,563 white participants aged 65–80 yrs (from the Cardiovascular Health Study) we evaluated the association of LMS-defined respiratory impairment with the incident of COPD hospitalisation and the competing outcome of death without COPD hospitalisation, over a 5-yr period. Respiratory impairment included airflow limitation (mild, moderate or severe) and restrictive pattern. Over a 5-yr period, 276 (7.7%) participants had a COPD hospitalisation incident, whereas 296 (8.3%) died without COPD hospitalisation. The risk of COPD hospitalisation was elevated more than two-fold in LMS-defined mild and moderate airflow limitation and restrictive pattern (adjusted HR (95% CI): 2.25 (1.25–4.05), 2.54 (1.53– 4.22) and 2.65 (1.82–3.86), respectively), and more than eight-fold in LMS-defined severe airflow limitation (adjusted HR (95% CI) 8.33 (6.24–11.12)). Conversely, only LMS-defined restrictive-pattern was associated with the competing outcome of death without COPD hospitalisation (adjusted HR (95% CI) 1.68 (1.22–2.32)). In older white persons, LMS-defined respiratory impairment is strongly associated with an increased risk of COPD hospitalisation. These results support the LMS method as a basis for defining respiratory impairment in older persons.