Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Respirology. 2024 Jun;29(6):471-478. doi: 10.1111/resp.14683. Epub 2024 Feb 25.
Prognostic indices have been developed to predict various outcomes, including mortality. These indices and hazard ratios may be difficult for patients to understand. We investigated the association between smoking, respiratory symptoms and lung function with remaining life expectancy (LE) in older adults.
Data were from the 2004/05 English Longitudinal Study of Ageing (ELSA) (n = 8930), participants aged ≥50-years, with mortality data until 2012. Respiratory symptoms included were chronic phlegm and shortness of breath (SOB). The association between smoking, respiratory symptoms and FEV/FVC, and remaining LE was estimated using a parametric survival function and adjusted for covariates including age at baseline and sex.
The extent to which symptoms and FEV/FVC predicted differences in remaining LE varied by smoking. Compared to asymptomatic never smokers with normal lung function (the reference group), in never smokers, only those with SOB had a significant reduction in remaining LE. In former and current smokers, those with respiratory symptoms had significantly lower remaining LE compared to the reference group if they had FEV/FVC <0.70 compared to those with FEV/FVC ≥0.70. Males aged 50-years, current smokers with SOB and FEV/FVC <0.70, had a remaining LE of 19.2 (95%CI: 16.5-22.2) years, a decrease of 8.1 (5.3-10.8) years, compared to the reference group.
Smoking, respiratory symptoms and FEV/FVC are strongly associated with remaining LE in older people. The use of remaining LE to communicate mortality risk to patients needs further investigation.
预后指数被用来预测各种结局，包括死亡率。这些指数和风险比可能使患者难以理解。我们研究了吸烟、呼吸系统症状和肺功能与老年人剩余预期寿命（LE）之间的关系。
数据来自 2004/05 年英国老龄化纵向研究（ELSA）（n=8930），参与者年龄≥50 岁，直至 2012 年有死亡数据。呼吸系统症状包括慢性咳痰和呼吸急促（SOB）。使用参数生存函数估计吸烟、呼吸系统症状与 FEV/FVC 之间的关系，以及剩余 LE，调整了基线时的年龄和性别等协变量。
症状和 FEV/FVC 对剩余 LE 差异的预测程度因吸烟而异。与无症状、肺功能正常的从不吸烟者（参考组）相比，从不吸烟者中只有 SOB 者的剩余 LE 显著降低。在以前和现在的吸烟者中，如果 FEV/FVC<0.70，有呼吸系统症状的人比参考组的剩余 LE 明显降低，而 FEV/FVC≥0.70 的人则没有。50 岁的男性，有 SOB 和 FEV/FVC<0.70 的当前吸烟者，剩余 LE 为 19.2 年（95%CI：16.5-22.2），比参考组减少了 8.1 年（5.3-10.8）。
吸烟、呼吸系统症状和 FEV/FVC 与老年人的剩余 LE 密切相关。使用剩余 LE 向患者传达死亡率风险需要进一步研究。
