BACKGROUND: Population studies that assess lung function usually exclude results of individuals with poor-quality measurements, which often means excluding many subjects. Impaired cognition is frequently associated with poor-quality spirometry; excluding such subjects may introduce a selection bias in studies with lung function as either outcome or exposure. We investigated the association between poor-quality spirometry and impaired cognitive function and whether poor-quality spirometry is associated with future mortality risk independently of cognitive function. METHODS: We used data from a prospective cohort in three Central and Eastern European countries; 12,087 individuals aged 45-75 years (54% females) with complete information on variables of interest were included. Standard memory, verbal fluency, and executive cognitive domain tests were converted into latent variable z-scores and divided into quartiles. Spirometry tests were classified into two categories based on repeatability criteria: good- (71%) vs. poor-quality spirometry (29% of participants). Those with good-quality spirometry were further classified, using forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as healthy spirometry (63%) or impaired spirometry (8%). Multinomial logistic regression was used to assess the association between poor-quality spirometry and cognitive function, and a Cox proportional regression was used to analyze the risk of total mortality over a 17-year follow-up. RESULTS: After controlling for a range of covariates, higher cognitive function predicted lower odds of poor-quality spirometry. In the highest cognitive function quartile, compared with the lowest quartile, the odds ratio of poor-quality spirometry was 0.82 (95%CI: 0.72-0.92). Impaired spirometry was associated with higher mortality risk even after adjusting for cognition (adjusted hazard ratio 1.63, 95%CI: 1.45-1.84), but mortality risk was similar in subjects with poor- vs. good-quality (HR 1.02, 95%CI: 0.93-1.10). CONCLUSION: Higher cognitive function was associated with a lower risk of poor-quality spirometry. The lack of independent association of poor-quality spirometry with mortality suggests that excluding poor-quality spirometry measurements from analyses is unlikely to introduce a major bias. However, discarding poor-quality spirometry from epidemiological analyses might imply the exclusion of vulnerable subjects. These findings should be confirmed in future studies representing other populations.

• Klíčová slova
• Aging, Cognition, Lung function, Mortality, Quality of spirometry,
• Publikační typ
• časopisecké články MeSH

AIMS: Impaired lung function has been strongly associated with cardiovascular disease (CVD) events. We aimed to assess the additive prognostic value of spirometry indices to the risk estimation of CVD events in Eastern European populations in this study. METHODS: We randomly selected 14,061 individuals with a mean age of 59 ± 7.3 years without a previous history of cardiovascular and pulmonary diseases from population registers in the Czechia, Poland, and Lithuania. Predictive values of standardised Z-scores of forced expiratory volume measured in 1 s (FEV1), forced vital capacity (FVC), and FEV1 divided by height cubed (FEV1/ht3) were tested. Cox proportional hazards models were used to estimate hazard ratios (HRs) of CVD events of various spirometry indices over the Framingham Risk Score (FRS) model. The model performance was evaluated using Harrell's C-statistics, likelihood ratio tests, and Bayesian information criterion. RESULTS: All spirometry indices had a strong linear relation with the incidence of CVD events (HR ranged from 1.10 to 1.12 between indices). The model stratified by FEV1/ht3 tertiles had a stronger link with CVD events than FEV1 and FVC. The risk of CVD event for the lowest vs. highest FEV1/ht3 tertile among people with low FRS was higher (HR: 2.35; 95% confidence interval: 1.96-2.81) than among those with high FRS. The addition of spirometry indices showed a small but statistically significant improvement of the FRS model. CONCLUSIONS: The addition of spirometry indices might improve the prediction of incident CVD events particularly in the low-risk group. FEV1/ht3 is a more sensitive predictor compared to other spirometry indices.

• Klíčová slova
• cardiovascular disease, cohort studies, mortality, pulmonary function test, risk prediction model,
• Publikační typ
• časopisecké články MeSH

It is unclear whether the dose-response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002-2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose-response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11-16 years of follow-up. Mortality rate increased in a dose-response manner from highest to lower FEV1/height3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18-1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29-2.63), 2.35 (1.67-3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.

• MeSH
• kardiovaskulární nemoci * epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plíce MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: The association between impaired lung function and mortality has been well documented in the general population of Western European countries. We assessed the risk of death associated with reduced spirometry indices among people from four Central and Eastern European countries. METHODS: This prospective population-based cohort includes men and women aged 45-69 years, residents in urban settlements in Czech Republic, Poland, Russia and Lithuania, randomly selected from population registers. The baseline survey in 2002-2005 included 36,106 persons of whom 24,993 met the inclusion criteria. Cox proportional hazards models were used to estimate the hazard ratios of mortality over 11-16 years of follow-up for mild, moderate, moderate-severe and very severe lung function impairment categories. RESULTS: After adjusting for covariates, mild (hazard ratio (HR): 1.25; 95% CI 1.15‒1.37) to severe (HR: 3.35; 95% CI 2.62‒4.27) reduction in FEV1 was associated with an increased risk of death according to degree of lung impairment, compared to people with normal lung function. The association was only slightly attenuated but remained significant after exclusion of smokers and participants with previous history of respiratory diseases. The HRs varied between countries but not statistically significant; the highest excess risk among persons with more severe impairment was seen in Poland (HR: 4.28, 95% CI 2.14‒8.56) and Lithuania (HR: 4.07, 95% CI 2.21‒7.50). CONCLUSIONS: Reduced FEV1 is an independent predictor of all-cause mortality, with risk increasing with the degree of lung function impairment and some country-specific variation between the cohorts.

• Klíčová slova
• Cohort study, Forced expiratory volume in one second, Mortality, Pulmonary function test,
• MeSH
• kardiovaskulární nemoci * epidemiologie   MeSH
• kohortové studie MeSH
• lidé MeSH
• plíce MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Polsko epidemiologie   MeSH