Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community-based cohort study

被引:127
作者
Duong, MyLinh [1 ,2 ,3 ]
Islam, Shofiqul [1 ,2 ]
Rangarajan, Sumathy [1 ,2 ]
Leong, Darryl [1 ,2 ]
Kurmi, Om [1 ,2 ]
Teo, Koon [1 ,2 ]
Killian, Kieran [1 ,2 ]
Dagenais, Gilles [4 ]
Lear, Scott [5 ,6 ,7 ]
Wielgosz, Andreas [8 ]
Nair, Sanjeev [9 ,10 ]
Mohan, Viswanathan [11 ]
Mony, Prem [12 ]
Gupta, Rajeev [13 ]
Kumar, Rajesh [14 ]
Rahman, Omar [15 ,16 ]
Yusoff, Khalid [17 ,18 ]
du Plessis, Johannes Lodewykus [19 ]
Igumbor, Ehimario U. [20 ]
Chifamba, Jephat [21 ]
Li, Wei [22 ,23 ]
Lu, Yin [22 ,23 ]
Zhi, Fumin [22 ,23 ]
Yan, Ruohua [22 ,23 ]
Iqbal, Romaina [24 ]
Ismail, Noorhassim [25 ]
Zatonska, Katarzyna [26 ]
Karsidag, Kubilay [27 ]
Rosengren, Annika [28 ,29 ]
Bahonar, Ahmad [30 ]
Yusufali, Afazalhussein [31 ]
Lamelas, Pablo M. [32 ]
Avezum, Alvaro [33 ]
Lopez-Jaramillo, Patricio [34 ]
Lanas, Fernando [35 ]
O'Byrne, Paul M. [1 ,2 ]
Yusuf, Salim [1 ,2 ]
机构
[1] McMaster Univ, Populat Hlth Res Inst, Dept Med, Hamilton, ON L8V 1C3, Canada
[2] Hamilton Hlth Sci, Hamilton, ON, Canada
[3] McMaster Univ, Res Inst St Joes Hamilton, Hamilton, ON, Canada
[4] Univ Laval, Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada
[5] Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada
[6] Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada
[7] Simon Fraser Univ, Dept Biomed Physiol & Kinesiol, Vancouver, BC, Canada
[8] Univ Ottawa, Dept Med, Ottawa, ON, Canada
[9] Med Coll, Dept Pulm Med, Thiruvananthapuram, Kerala, India
[10] Hlth Act People, Thiruvananthapuram, Kerala, India
[11] Madras Diabet Res Fdn, Chennai, Tamil Nadu, India
[12] St Johns Res Inst, Community Hlth & Epidemiol, Bangalore, Karnataka, India
[13] Eternal Heart Care Ctr & Res Inst, Jaipur, Rajasthan, India
[14] PGIMER, Sch Publ Hlth, Chandigarh, India
[15] Independent Univ, Dept Community Med, Dhaka, Bangladesh
[16] Independent Univ, Sch Publ Hlth, Dhaka, Bangladesh
[17] Univ Teknol MARA, Sungai Buloh, Selangor, Malaysia
[18] UCSI, Kuala Lumpur, Malaysia
[19] North West Univ, Occupat Hyg & Hlth Res Initiat, Potchefstroom, North West Prov, South Africa
[20] Univ Western Cape, Sch Publ Hlth, Cape Town, South Africa
[21] Univ Zimbabwe, Coll Hlth Sci, Dept Physiol, Harare, Zimbabwe
[22] Peking Union Med Coll, State Key Lab Cardiovasc Dis, Fuwai Hosp, Natl Ctr Cardiovasc Dis, Beijing, Peoples R China
[23] Chinese Acad Med Sci, Beijing, Peoples R China
[24] Aga Khan Univ, Dept Community Hlth Sci & Med, Karachi, Sindh, Pakistan
[25] Univ Kebangsaan Malaysia, Dept Community Hlth, Fac Med, Kuala Lumpur, Malaysia
[26] Med Univ Wroclaw, Dept Social Med, Wroclaw, Poland
[27] Istanbul Univ, Div Endocrinol, Dept Internal Med, Fac Med, Istanbul, Turkey
[28] Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med, Gothenburg, Sweden
[29] Sahlgrens Univ Hosp, Gothenburg, Sweden
[30] Isfahan Univ Med Sci, Cardiovasc Res Inst, Hypertens Res Ctr, Esfahan, Iran
[31] Dubai Med Univ, Hatta Hosp, Dubai Hlth Author, Dubai, U Arab Emirates
[32] Estudios Clin Latinoamer ECLA, Rosario, Santa Fe, Argentina
[33] Dante Pazzanese Inst Cardiol, Sao Paulo, SP, Brazil
[34] Fdn Oftalmol Santander FOSCAL, Floridablanca, Santander, Colombia
[35] Univ La Frontera, Temuco, Chile
来源
LANCET GLOBAL HEALTH | 2019年 / 7卷 / 05期
基金
加拿大健康研究院;
关键词
LUNG-FUNCTION; PULMONARY-FUNCTION; PROSPECTIVE URBAN; RISK; POPULATION; QUESTIONNAIRE; DISEASES; HEALTH; LIFE;
D O I
10.1016/S2214-109X(19)30070-1
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background The associations between the extent of forced expiratory volume in 1 s (FEV1) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations are unclear, and how these associations might vary across populations is unknown. Methods In this international, community-based cohort study, we prospectively enrolled adults aged 35-70 years who had no intention of moving residences for 4 years from rural and urban communities across 17 countries. A portable spirometer was used to assess FEV1. FEV1 values were standardised within countries for height, age, and sex, and expressed as a percentage of the country-specific predicted FEV1 value (FEV1%). FEV1% was categorised as no impairment (FEV1% >= 0 SD from country-specific mean), mild impairment (FEV1% <0 SD to -1 SD), moderate impairment (FEV1% <-1 SD to -2 SDs), and severe impairment (FEV1% <-2 SDs [ie, clinically abnormal range]). Follow-up was done every 3 years to collect information on mortality, cardiovascular disease outcomes (including myocardial infarction, stroke, sudden death, or congestive heart failure), and respiratory hospitalisations (from chronic obstructive pulmonary disease, asthma, pneumonia, tuberculosis, or other pulmonary conditions). Fully adjusted hazard ratios (HRs) were calculated by multilevel Cox regression. Findings Among 126 359 adults with acceptable spirometry data available, during a median 7.8 years (IQR 5.6-9.5) of follow-up, 5488 (4.3%) deaths, 5734 (4.5%) cardiovascular disease events, and 1948 (1.5%) respiratory hospitalisation events occurred. Relative to the no impairment group, mild to severe FEV1% impairments were associated with graded increases in mortality (HR 1.27 [95% CI 1.18-1.36] for mild, 1.74 [1.60-1.90] for moderate, and 2.54 [2.26-2.86] for severe impairment), cardiovascular disease (1.18 [1.10-1.26], 1.39 [1.28-1.51], 2.02 [1.75-2.32]), and respiratory hospitalisation (1.39 [1.24-1.56], 2.02 [1.75-2.32], 2.97 [2.45-3.60]), and this pattern persisted in subgroup analyses considering country income level and various baseline risk factors. Population-attributable risk for mortality (adjusted for age, sex, and country income) from mildly to moderately reduced FEV1% (24.7% [22.2-27.2]) was larger than that from severely reduced FEV1% (3.7% [2.1-5.2]) and from tobacco use (19.7% [17.2-22.3]), previous cardiovascular disease (5.5% [4.5-6.5]), and hypertension (17.1% [14.6-19.6]). Population-attributable risk for cardiovascular disease from mildly to moderately reduced FEV1 was 17.3% (14.8-19.7), second only to the contribution of hypertension (30.1% [27.6-32.5]). Interpretation FEV1 is an independent and generalisable predictor of mortality, cardiovascular disease, and respiratory hospitalisation, even across the clinically normal range (mild to moderate impairment). Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
引用
收藏
页码:E613 / E623
页数:11
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