Title : Association between all-cause and cardiovascular mortality and lung function across the full range of distribution: results from HAPIEE cohort study
Background: Impaired lung function has been established as an independent predictor of mortality but there is less evidence on the mortality risk in persons with preserved lung function. We assessed the pattern of all-cause and cardiovascular mortality across the full distribution of forced expiratory volume in one second (FEV1) of people from four Central and Eastern European countries.
Methods: The prospective population-based HAPIEE cohort includes randomly selected people with a mean age of 59 ±7.3 years from population registers in Czech Republic, Poland, Russia and Lithuania. The baseline survey in 2002-2005 included 36106 persons of whom 24944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose-response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11-16 years of follow-up.
Results: Mortality rate increased in a dose-response manner from highest to lower FEV1/height3 deciles. For both all-cause and cardiovascular mortality, we observed approximately linear and statistically significant trends (p<0.001). Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI: 1.08?1.49), 1.37 (1.18-1.60) and 2.15 (1.86?2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29-2.63), 2.35 (1.67-3.28) and 3.46 (2.50?4.78). Patterns were similar across countries, with some statistically insignificant variation.
Conclusions: FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function. The strongest association seen with deaths from cardiovascular causes.