A predominant decrease in forced expiratory volume in 1 second (FEV1) is strongly associated with respiratory mortality, especially noncancer-related deaths, according to study findings published in Respiratory Medicine.
Researchers evaluated the relationship of FEV1, forced vital capacity (FVC), obstructive spirometric pattern (OSP), and restrictive spirometric pattern (RSP) with all-cause and cause-specific mortality with use of the Pneumoconiosis Survey of Western Norway.
The survey was conducted in Norway from October 1988 to September 1990 among men born between 1944 and 1958 (aged 30-46 years, n=45,380) who were living in the study area on January 1, 1988. A mobile unit performed chest radiographs and spirometry on participants.
Mortality and emigration data were obtained through December 31, 2016. Cox proportional hazard models were used to estimate the association of FEV1 and FVC z-scores with all-cause and cause-specific mortality.
The analysis included 26,118 individuals with 3 complete recordings of FEV1 and FVC. Their mean age was 38.2 years (range, 30-46 years), and the mean follow-up was 26.3 years (685,163 person-years).
A total of 2462 (9%) individuals died, and 262 (1%) emigrated. Among the deaths, 786 (32%) were cancer related, 609 (25%) were cardiovascular, 350 (14%) were respiratory, 283 (11%) were non-natural, and the remaining 434 deaths were classified as other (18%).
Significant associations were observed for FEV1 and FVC with all-cause, cancer, cardiovascular, respiratory, and other-cause mortality after adjustment for age, body mass index, smoking status, and education. In subgroup analyses for respiratory mortality, stronger associations of FEV1 and FVC were found for noncancer respiratory deaths (hazard ratios [HRs], 2.29 and 1.78 per 1 unit z-score decrease) compared with lung cancer deaths (HRs, 1.27 and 1.14).
Significant associations were observed regarding FEV1 and FVC with cardiovascular and diabetes deaths, with the strongest association for lung function parameters occurring for diabetes mortality (HRs, 2.21 and 2.41, per 1-unit z-score decrease), followed by cerebrovascular disease (HRs, 1.52 and 1.54), heart failure (HR 1.39 and 1.44) and ischemic heart disease (HRs, 1.22 and 1.21).
A significant association was observed for FEV1 and FVC with deaths due to suicide (HRs, 1.37 and 1.29, per 1-unit z-score decrease). Strong associations were observed for FEV1 and FVC with mortality from diseases of the nervous system (HRs, 1.56 and 1.61), but not for mortality related to alcohol abuse.
Overall, RSP was strongly associated (1.5- to 2-fold increase in HR vs absence of RSP) with all types of mortality except a non-natural cause, and OSP had weaker associations except for respiratory mortality (HR, 2.77 vs absence of OSP). OSP was primarily associated with respiratory noncancer (HR, 6.20) and lung cancer mortality (HR, 1.95), and RSP was mostly related to diabetes (HR, 5.62) and cerebrovascular disease (HR, 4.16).
Among several limitations, misclassification of causes of death is possible, and COPD was underdiagnosed at the time of the study. Also, only spirometric data were used, information on incident disease was not available, the study was limited to men, and covariates were available only at baseline.
“We found many significant associations of FEV1 and FVC with cause-specific mortality in a general population of 30- to 46-year-old men followed for 26 years,” the investigators stated. “Most notably, FEV1 was strongly associated with respiratory mortality, especially non-cancer related. Both FEV1 and FVC were associated with diabetes, cardiovascular, neurologic, suicide, and hematologic cancer mortality.”
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Cestelli L, Gulsvik A, Johannessen A, Stavem K, Nielsen R. Reduced lung function and cause-specific mortality: a population-based study of Norwegian men followed for 26 years. Respir Med. Published online September 28, 2023. doi:10.1016/j.rmed.2023.107421