title: Lung function decline over 25 years of follow-up among black and white adults in the ARIC study cohort.
abstract: BACKGROUND
  Interpretation of longitudinal information about lung function decline from middle to older age has been limited by loss to follow-up that may be correlated with baseline lung function or the rate of decline. We conducted these analyses to estimate age-related decline in lung function across groups of race, sex, and smoking status while accounting for dropout from the Atherosclerosis Risk in Communities Study.
  
  
  METHODS
  We analyzed data from 13,896 black and white participants, aged 45-64 years at the 1987-1989 baseline clinical examination. Using spirometry data collected at baseline and two follow-up visits, we estimated annual population-averaged mean changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) by race, sex, and smoking status using inverse-probability-weighted independence estimating equations conditioning-on-being-alive.
  
  
  RESULTS
  Estimated rates of FEV1 decline estimated using inverse-probability-weighted independence estimating equations conditioning on being alive were higher among white than black participants at age 45 years (e.g., male never smokers: black: -29.5 ml/year; white: -51.9 ml/year), but higher among black than white participants by age 75 (black: -51.2 ml/year; white: -26). Observed differences by race were more pronounced among men than among women. By smoking status, FEV1 declines were larger among current than former or never smokers at age 45 across all categories of race and sex. By age 60, FEV1 decline was larger among former and never than current smokers. Estimated annual declines generated using unweighted generalized estimating equations were smaller for current smokers at younger ages in all four groups of race and sex compared with results from weighted analyses that accounted for attrition.
  
  
  CONCLUSIONS
  Using methods accounting for dropout from an approximately 25-year health study, estimated rates of lung function decline varied by age, race, sex, and smoking status, with largest declines observed among current smokers at younger ages.
authors.affiliation: Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-60, Atlanta, GA 30341, USA. Electronic address: mmirabelli@cdc.gov.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Mirabelli
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3101 McGavran-Greenberg Hall, CB 7420, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Preisser
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB 7400, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.affiliation: Department of Medicine, Johns Hopkins University, 2020 E. Monument Street, Room B-321, Baltimore, MD 21287, USA.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3101 McGavran-Greenberg Hall, CB 7420, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Couper
authors.affiliation: Hankinson Consulting, Inc., 1860 Barnett Shoals Road, Suite 103, PMB 505, Athens, GA 30605-6821, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Hankinson
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3101 McGavran-Greenberg Hall, CB 7420, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
authors.forename: Noorie
authors.initials: N
authors.lastname: Hyun
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd Street, Suite 300, Minneapolis, MN 55454, USA.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, 111 TW Alexander Drive, PO Box 12233, MD A3-05, Research Triangle Park, NC 27709, USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: London
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000453:epidemiology* / Q000208:ethnology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000208:ethnology* / Q000503:physiopathology; D013147:Spirometry; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: Aging; Epidemiology; Lung function tests; Respiratory; Spirometry