Sanders Jason Leigh, Axelsson Gisli, Putman Rachel, Menon Aravind, Dupuis Josée, Xu Hanfei, Wang Shuai, Murabito Joanne, Vasan Ramachandran, Araki Tetsuro, Nishino Mizuki, Washko George R, Hatabu Hiroto, O'Connor George, Gudmundsson Gunnar, Gudnason Vilmundur, Hunninghake Gary M
Vertex Pharmaceuticals Incorporated, Boston, Massachusetts, USA.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Thorax. 2023 Jun;78(6):559-565. doi: 10.1136/thoraxjnl-2021-218315. Epub 2022 Jul 1.
Interstitial lung abnormalities (ILAs) are associated with increased mortality. It is unclear whether multimorbidity accounts for the mortality association or how strongly ILA is associated with mortality relative to other common age-associated diseases. We determined the association of ILA with all-cause mortality adjusted for multimorbidity, compared mortality associated with ILA and prevalent cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease and cancer and also determined the association between ILA and these diseases.
We measured ILA (none, indeterminant, definite) using blinded reads of CT images, prevalent chronic diseases and potential confounders in two observational cohorts, the Framingham Heart Study (FHS) (n=2449) and Age, Gene/Environment Susceptibility - Reykjavik Study (AGES-Reykjavik) (n=5180). We determined associations with mortality using Cox proportional hazards models and between ILA and diseases with multinomial logistic regression.
Over a median (IQR) follow-up of 8.8 (1.4) years in FHS and 12.0 (7.7) years in AGES-Reykjavik, in adjusted models, ILAs were significantly associated with increased mortality (HR, 95% CI 1.95, 1.23 to 3.08, p=0.0042, in FHS; HR 1.60, 1.41 to 1.82, p<0.0001, in AGES-Reykjavik) adjusted for multimorbidity. In both cohorts, the association of ILA with mortality was of similar magnitude to the association of most other diseases. In adjusted models, ILAs were associated only with prevalent kidney disease (OR, 95% CI 1.90, 1.01 to 3.57, p=0.0452) in FHS and with prevalent CVD (OR 1.42, 1.12 to 1.81, p=0.0040) in AGES-Reykjavik.
ILAs were associated with mortality adjusted for multimorbidity and were similarly associated with increased mortality compared with several common chronic diseases. ILAs were not consistently associated with the prevalence of these diseases themselves.
间质性肺异常（ILA）与死亡率增加相关。目前尚不清楚多种疾病并存是否可解释这种死亡率关联，也不清楚相对于其他常见的与年龄相关的疾病，ILA与死亡率的关联强度如何。我们确定了经多种疾病并存因素调整后ILA与全因死亡率的关联，比较了与ILA和常见心血管疾病（CVD）、糖尿病、慢性肾脏病、慢性阻塞性肺疾病及癌症相关的死亡率，并确定了ILA与这些疾病之间的关联。
我们在两项观察性队列研究中，即弗雷明汉心脏研究（FHS，n = 2449）和年龄、基因/环境易感性 - 雷克雅未克研究（AGES - 雷克雅未克，n = 5180）中，通过对CT图像进行盲法解读来测量ILA（无、不确定、明确）、常见慢性病及潜在混杂因素。我们使用Cox比例风险模型确定与死亡率的关联，并使用多项逻辑回归确定ILA与疾病之间的关联。
在FHS中，中位（四分位间距）随访时间为8.8（1.4）年；在AGES - 雷克雅未克中为12.0（7.7）年。在调整模型中，经多种疾病并存因素调整后，ILA与死亡率显著相关（FHS中，HR，95%CI 1.95，1.23至3.08，p = 0.0042；AGES - 雷克雅未克中，HR 1.60，1.41至1.82，p < 0.0001）。在两个队列中，ILA与死亡率的关联程度与大多数其他疾病的关联程度相似。在调整模型中，在FHS中ILA仅与现患肾病相关（OR，95%CI 1.90，1.01至3.57，p = 0.0452），在AGES - 雷克雅未克中与现患CVD相关（OR 1.42，1.12至1.81，p = 0.0
