Backman Helena, Sawalha Sami, Nilsson Ulf, Hedman Linnea, Stridsman Caroline, Vanfleteren Lowie E G W, Nwaru Bright I, Stenfors Nikolai, Rönmark Eva, Lindberg Anne
Section of Sustainable Health/The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241232768. doi: 10.1177/17534666241232768.
Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated.
To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF).
Population-based prospective cohort study.
Individuals with CAO [FEV/vital capacity (VC) < 0.70], RSP [FEV/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years.
The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes.
The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.
慢性气道阻塞（CAO）和限制性肺量计模式（RSP）与死亡率相关，但全因死亡率和特定死因的性别差异模式几乎未得到评估。
分别研究患有CAO和RSP的男性和女性与正常肺功能（NLF）者相比，在全因死亡率和特定死因死亡率模式方面可能存在的性别差异。
基于人群的前瞻性队列研究。
在2002年至2004年的瑞典北部阻塞性肺病（OLIN）研究中，确定了患有CAO[第一秒用力呼气容积（FEV）/肺活量（VC）<0.70]、RSP[FEV/VC≥0.70且用力肺活量（FVC）<预测值的80%]和NLF（FEV/VC≥0.70且FVC≥预测值的80%）的个体。收集截至2016年4月的死亡率数据，共涵盖19000患者年。采用Cox回归和考虑竞争风险的Fine-Gray回归来估计风险比（HR），并对年龄、体重指数、性别、吸烟习惯和吸烟包年数进行95%置信区间（CI）调整。
CAO和RSP组的全因死亡调整风险高于NLF组（HR，95%CI；1.69，1.31 - 2.02和1.24，1.06 - 1.71），且较高风险由男性驱动。CAO组的呼吸和心血管死亡风险高于NLF组（2.68，1.05 - 6.82和1.40，1.04 - 1.90）。呼吸死亡风险在女性中显著（3.41，1.05 - 11.07），而心血管死亡风险在男性中显著（1.49，1.01 - 2.22）。在RSP组中，调整后呼吸死亡风险仍然较高（2.68，1.05 - 6.82），但心血管死亡风险不高（1.11，0.74 - 1.66），男女模式相似。
CAO和RSP组的全因死亡风险高于NLF组是由男性驱动的。CAO与女性的呼吸死亡和男性的心血管死亡相关，而RSP与呼吸死亡相关，男女情况相似。
