Restrictive pulmonary dysfunction at spirometry and mortality in the elderly

Objectives: To evaluate the association between pulmonary restriction and mortality in the elderly, taking into account potential confounders not considered in the past (disability, cognitive dysfunction, diabetes, and visceral obesity). Design: Longitudinal study. Setting: Community-based. Participants: Twelve hundred sixty-five patients (51.9% men) aged 65-97 years old from the Salute Respiratoria nell'Anziano (SaRA) Italian multicentric study. Measurements: Participants were divided in 4 groups: normal spirometry (NS): FEV1/FVC >= 70%, FVC >= 80% of predicted; restrictive ventilatory pattern (RVP): FEV1/FVC >= 70%, FVC < 80%; obstructive ventilatory pattern (OVP): FEV1/FVC >= 70%, FVC >= 80%, and mixed ventilatory pattern (MVP): FEV1/FVC < 70%, FVC >= 80%. We calculated the association between restriction and mortality corrected for potential confounders using a multivariable Cox regression model. Results: We found a prevalence of RVP, OVP and MVP of 10.9%, 25.4%, and 17.3%, respectively. Compared to people with normal spirometric pattern, disability (19.6% vs. 10.1%), poor physical performance (35.4% vs. 22.3%), cognitive impairment (21.0% vs. 11.5%), increased waist circumference (62.1% and 26.8%), and kyphoscoliosis (56.8 and 13.5%) were more prevalent in the RVP group. After correction for potential confounders, RVP was associated with increased mortality (HR: 1.89; 95% CI: 1.15-3.11), as well as OVP (HR: 2.33; 95% CI: 1.58-3.11) and MVP (HR: 2.60; 95% CI: 1.74-3.93). Other factors associated with mortality were disability (HR: 1.92; 95% CI: 1.35-2.72), poor physical performance (HR: 1.37; 95% CI: 1.01-1.85), cognitive impairment (HR: 1.55; 95% CI: 1.06-2.27), depression (HR: 1.57; 95% CI: 1.16-2.13) and diagnosis of stroke (HR: 1.90; 95% CI: 1.18-3.05). Conclusions: RVP is associated with higher mortality in the elderly and, thus, deserves the same attention paid to an obstructive pattern. However, mechanisms mediating this association need to be clarified. (C) 2008 Elsevier Ltd. All rights reserved.