title: Association between all-cause and cause-specific mortality and the GOLD stages 1-4: A 30-year follow-up among Finnish adults.
abstract: BACKGROUND
  Mortality correlates with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria of airway obstruction. Yet, little data exist concerning the long-term survival of patients presenting with different levels of obstruction.
  
  
  METHODS
  We studied the association between all-cause and cause-specific mortality and GOLD stages 1-4 in a 30-year follow-up among 6636 Finnish men and women aged 30 or older participating in the Mini-Finland Health Study between 1978 and 1980.
  
  
  RESULTS
  After adjusting for age, sex, and smoking history, the GOLD stage of the subject showed a strong direct relationship with all-cause mortality, mortality from cardiovascular and respiratory diseases, and cancer. The adjusted hazard ratios of death were 1.27 (95% confidence interval (CI) 1.06-1.51), 1.40 (1.21-1.63), 1.55 (1.21-1.97) and 2.85 (1.65-4.94) for GOLD stages 1-4, respectively, with FEV1/FVC ≥70% as the reference. The association between GOLD stages 2-4 and mortality was strongest among subjects under 50 years of age at the baseline measurement. Cardiovascular mortality increased consistently for all GOLD stages.
  
  
  CONCLUSIONS
  Airway obstruction indicates an increased risk for all-cause mortality according to the severity of the GOLD stage. We found that even stage 1 carries a risk for cardiovascular death independently of smoking history and other known risk factors.
authors.affiliation: Department of Lung Diseases, Helsinki University Hospital, Meilahti Triangle Hospital, 6th Floor, PO Box 372, 00029 HUS, Finland. Electronic address: tiina.m.mattila@fimnet.fi.
authors.forename: Tiina
authors.initials: T
authors.lastname: Mattila
authors.affiliation: Finnish Lung Health Association (FILHA), Filha ry, Sibeliuksenkatu 11 A 1, 00250 Helsinki, Finland. Electronic address: tuula.vasankari@filha.fi.
authors.forename: Tuula
authors.initials: T
authors.lastname: Vasankari
authors.affiliation: School of Health Sciences, University of Tampere, Niittytie 1, 33470 Ylöjärvi, Finland. Electronic address: Merja.Kanervisto@uta.fi.
authors.forename: Merja
authors.initials: M
authors.lastname: Kanervisto
authors.affiliation: Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, PO Box 52 (Hämeentie 11), 20521 Turku, Finland. Electronic address: tarja.helena.laitinen@tyks.fi.
authors.forename: Tarja
authors.initials: T
authors.lastname: Laitinen
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Electronic address: olli.impivaara@thl.fi.
authors.forename: Olli
authors.initials: O
authors.lastname: Impivaara
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Electronic address: harri.rissanen@thl.fi.
authors.forename: Harri
authors.initials: H
authors.lastname: Rissanen
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Electronic address: paul.knekt@thl.fi.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Electronic address: pekka.jousilahti@thl.fi.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jousilahti
authors.affiliation: Department of Respiratory Medicine, Tampere University Hospital, 33521 Tampere, Finland. Electronic address: seppo.saarelainen@pshp.fi.
authors.forename: Seppo
authors.initials: S
authors.lastname: Saarelainen
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Electronic address: pauli.puukka@thl.fi.
authors.forename: Pauli
authors.initials: P
authors.lastname: Puukka
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. Electronic address: markku.heliovaara@thl.fi.
authors.forename: Markku
authors.initials: M
authors.lastname: Heliövaara
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D005544:Forecasting; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014797:Vital Capacity
keywords: COPD; Epidemiological study; Mortality; Respiratory epidemiology