title: Lung function decline and outcomes in an adult population.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality.
  
  
  OBJECTIVE
  To determine risk factors for and outcomes of rapid lung function decline in a cohort of adults in the United States.
  
  
  METHODS
  We analyzed data from 15,536 adults aged 44-66 yr in the Atherosclerosis Risk in Communities study. We used Cox proportional hazard models to determine the risk of rapid lung function decline at 3 yr on mortality and COPD hospitalizations over the subsequent 8 yr.
  
  
  RESULTS
  Of those in the baseline cohort, 13,756 (88.5%) had spirometry at the Year 3 visit. The strongest risk factors for not having a follow-up spirometry were as follows: having Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3 or 4 disease at baseline (adjusted odds ratio [OR] 2.8; 95% confidence interval [CI], 2.1-3.8), being black (adjusted OR, 2.4; 95% CI, 2.1-2.7), and being a current smoker (adjusted OR, 1.8; 95% CI, 1.5-2.0). Participants with GOLD stage 3 or 4 disease were also more likely to be in the most rapidly declining lung function quartile (adjusted OR, 3.7; 95% CI, 2.7-5.0). Overall, participants with the most rapidly declining lung function had a modestly increased risk of death (adjusted hazard ratio, 1.4; 95% CI, 1.2-1.7) and time to a COPD-related hospitalization (adjusted hazard ratio, 1.4; 95% CI, 1.2-1.8).
  
  
  CONCLUSIONS
  Rapid lung function decline was independently associated with a modest increased risk of COPD hospitalizations and deaths.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical 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: Matthew M
authors.initials: MM
authors.lastname: Reichert
authors.forename: Kourtney J
authors.initials: KJ
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D012307:Risk Factors; D013147:Spirometry; D015996:Survival Rate; D014481:United States; D014797:Vital Capacity