Why does lung function predict mortality? Results from the Whitehall II Cohort Study.
The authors examined the extent to which socioeconomic position, behavior-related factors, cardiovascular risk factors, inflammatory markers, and chronic diseases explain the association between poor lung function and mortality in 4,817 participants (68.9% men) from the Whitehall II Study aged 60.8 years (standard deviation, 5.9), on average. Forced expiratory volume in 1 second (FEV(1)) was used to measure lung function in 2002-2004. A total of 139 participants died during a mean follow-up period of 6.4 years (standard deviation, 0.8). In a model adjusted for age and sex, being in the lowest tertile of FEV(1)/height(2) was associated with a 1.92-fold (95% confidence interval: 1.35, 2.73) increased risk of mortality compared with being in the top 2 tertiles. Once age, sex, and smoking history were taken into account, the most important explanatory factors for this association were inflammatory markers (21.3% reduction in the FEV(1)/height(2)-mortality association), coronary heart disease, stroke, and diabetes (11.7% reduction), and alcohol consumption, diet, physical activity, and body mass index (9.8% reduction). The contribution of socioeconomic position and cardiovascular risk factors was small (≤ 3.5% reduction). Taken together, these factors explained 32.5% of the association. Multiple pathways link lung function to mortality; these results show inflammatory markers to be particularly important.
INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul-Brousse, 16 avenue Paul Vaillant Couturier, Bâtiment 15/16, F-94807, Villejuif, France. Severine.Sabia@inserm.fr
Séverine
S
Sabia
Martin
M
Shipley
Alexis
A
Elbaz
Michael
M
Marmot
Mika
M
Kivimaki
Francine
F
Kauffmann
Archana
A
Singh-Manoux
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000401:mortality* / Q000523:psychology; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D007249:Inflammation / Q000097:blood; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D006113:United Kingdom
D015415:Biomarkers