title: Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study.
abstract: OBJECTIVE
  To determine whether a modified Global Initiative on Obstructive Lung Diseases (GOLD) classification of chronic obstructive pulmonary disease (COPD) predicts mortality in a cohort of subjects followed for up to 11 years.
  
  
  METHODS
  We analyzed data from 15,759 adult participants, aged 43-66 years at baseline, in the Atherosclerosis Risk in Communities (ARIC) study. All baseline and follow-up data were available for 15,440 (97.9%) of the initial participants. We classified subjects using a modification of the GOLD criteria for COPD (prebronchodilator forced expiratory volume in 1s (FEV(1)) stratification of disease severity), and added a "restricted" category (FEV(1)/FVC>70% and FVC<80% predicted). We used Cox proportional hazard models to determine the risk of impaired lung function on subsequent mortality, after adjusting for age, race, sex and smoking status.
  
  
  RESULTS
  1242 (8.0%) subjects died by the end of 1997. The overall rate of death was 8.9 per 1000 person years, but varied from 5.4/1000 among normal subjects to 42.9/1000 among subjects with GOLD Stage 3 or 4 COPD. After adjusting for covariates, all GOLD categories, along with the restricted category, predicted a higher risk of death: GOLD Stage 3 or 4, hazard ratio (HR) 5.7, 95% confidence interval (CI) 4.4, 7.3; GOLD Stage 2 HR 2.4, 95% CI 2.0, 2.9; GOLD Stage 1 HR 1.4, 95% CI 1.1, 1.6; GOLD Stage 0 HR 1.5, 95% CI 1.3, 1.8; and restricted HR 2.3, 95% CI 1.9, 2.8.
  
  
  CONCLUSIONS
  The modified GOLD classification system of COPD predicts mortality in this cohort of middle-aged Americans followed for up to 11 years.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Kentucky Medicial Center, 800 Rose Street, MN 614, Lexington, KY 40536, USA. dmannino@uky.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.forename: Dennis E
authors.initials: DE
authors.lastname: Doherty
authors.forename: A
authors.initials: A
authors.lastname: Sonia Buist
mesh_terms: D000328:Adult; D000368:Aged; D000569:Americas / Q000453:epidemiology; D044383:Black People; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000175:diagnosis / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D014797:Vital Capacity; D044465:White People