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Airflow limitation classified with the fixed ratio or the lower limit of normal and cause-specific mortality - A prospective study

Journal article
Authors Kjell Torén
M. Andersson
Anna-Carin Olin
P. D. Blanc
B. Jarvholm
Published in Respiratory Medicine
Volume 144
Pages 36-41
ISSN 0954-6111
Publication year 2018
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Pages 36-41
Language en
Links dx.doi.org/10.1016/j.rmed.2018.10.0...
Keywords Epidemiology, COPD, GOLD, Spirometry, Never smokers, Women, obstructive pulmonary-disease, swedish construction workers, lung-function, follow-up, general-population, society statement, increased risk, never-smokers, copd, cohort
Subject categories Public Health, Global Health, Social Medicine and Epidemiology

Abstract

Background: There is controversy as to whether airflow limitation should be defined as forced expiratory volume in 1 s (FEV1)/vital capacity (VC) < 0.7 or as FEV1/VC < the lower limit of normal (LLN). The aim was to examine whether different definitions of airflow limitation differ in predicting mortality. Methods: Longitudinal prospective study of a national cohort of Swedish workers (199,408 men; 7988 women), aged 20-64 years with spirometry without bronchodilation at baseline followed from 1979 until death, or censorship at 2010. Airflow limitation (AL) by Global Obstructive Lung Disease criteria, AL(GOLD), was defined as FEV1/VC < 0.7; AL(LLN) as FEV1/VC < LLN. All all-cause, COPD and cardiovascular disease mortality was analyzed among men and women in relation to ALGOLD and ALLLN, adjusted for age and smoking. Results: Among men, all-cause mortality risks were similar by airflow limitation criteria: AL(GOLD) RR = 1.32, 95% CI 1.26-1.38; AL(LLN), RR = 1.37, 95% CI 1.31-1.44. The risk estimates were also similar by airflow limitation definition for cardiovascular mortality and for COPD mortality. Among women, all-cause mortality was also similar by airflow limitation criteria, but significantly higher as compared to men: AL(GOLD) RR = 2.10, 95% CI 1.66-2.66; AL(LLN), RR = 2.09, 95% CI 1.66-2.62. Also cardiovascular and COPD mortality by airflow limitation criteria was significantly higher among women as compared to men. Conclusions: Defined either as FEV1/VC < 0.7 or as FEV1/VC < LLN, airflow limitation predicted excess mortality risk of similar magnitude. Mortality in relation to airflow limitation was higher among women compared to men.

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