Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
J Gerontol A Biol Sci Med Sci. 2023 Jul 8;78(7):1219-1226. doi: 10.1093/gerona/glac188.
Poor pulmonary function (PF) has been linked to mortality, but the timing of PF changes before death remains unclear. We aimed to examine the association between PF and mortality and identify different PF trajectories precedes death.
Within the Rush Memory and Aging Project, 1 438 participants without chronic obstructive pulmonary disease were followed for up to 22 years. PF was assessed annually using a composite score (tertiled as low, medium, and high) based on forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), and peak expiratory flow (PEF). Survival status was observed during the follow-up period. Data were analyzed using Cox regression, Laplace regression, and mixed-effect models.
During the follow-up, 737 (51.25%) participants died. Compared to high PF, the hazard ratio (95% confidence interval [CI]) of mortality was 1.35 (1.05, 1.72)/1.63 (1.25, 2.12) for medium/low PF. The median survival time (95% CI) was shortened by 0.80 (0.01-1.61)/1.72 (0.43-3.01) years for participants with medium/low PF, compared to high PF. In multiadjusted trajectory analysis, the significant differences between decedents and survivors occurred at 7 years before death for composite PF (mean difference [95% CI]: 0.14 [0.02-0.25]), 6 years for FEV1 (0.21 [0.08-0.33]) and FVC (0.21 [0.08-0.34]), and 8 years for PEF (0.21 [0.06-0.37]), and became greater thereafter.
Poor PF is associated with elevated mortality and shortens survival for nearly 2 years. An acceleration in PF decline tends to occur 7 years before death. Poor PF, together with its decline, might be a predictor of mortality among community-dwelling older adults.
肺功能不良（PF）与死亡率有关，但 PF 变化在死亡前的时间仍不清楚。我们旨在研究 PF 与死亡率之间的关系，并确定死亡前不同的 PF 轨迹。
在拉什记忆与衰老项目中，对 1438 名无慢性阻塞性肺疾病的参与者进行了长达 22 年的随访。PF 每年通过基于用力肺活量（FVC）、1 秒用力呼气量（FEV1）和呼气峰流速（PEF）的复合评分（分为低、中、高三个三分位）进行评估。在随访期间观察生存状况。使用 Cox 回归、Laplace 回归和混合效应模型进行数据分析。
在随访期间，737 名（51.25%）参与者死亡。与高 PF 相比，中/低 PF 的死亡风险比（95%置信区间[CI]）为 1.35（1.05，1.72）/1.63（1.25，2.12）。与高 PF 相比，中/低 PF 组的中位生存时间（95%CI）缩短了 0.80（0.01-1.61）/1.72（0.43-3.01）年。在多因素调整的轨迹分析中，复合 PF 在死亡前 7 年（平均差异[95%CI]：0.14[0.02-0.25]）、FEV1 在 6 年（0.21[0.08-0.33]）和 FVC 在 6 年（0.21[0.08-0.34]）、PEF 在 8 年（0.21[0.06-0.37]）出现显著差异，此后差异增大。
PF 不良与死亡率升高有关，并使生存时间缩短近 2 年。PF 下降加速倾向于在死亡前 7 年发生。PF 不良及其下降可能是社区居住的老年人死亡的预测指标。
