Age, period, and cohort effects on pulmonary function in a 24-year longitudinal study.

This paper proposes the use of two-factor models (age-period and age-cohort models) to estimate age, period, and cohort effects on pulmonary function by using the data collected in a 24-year longitudinal study in the Netherlands from 1965 to 1990. The analysis included 18,363 pulmonary function measurements on 6,148 subjects aged 20-54 years at the initial visit. The subjects were grouped into four birth cohorts (before 1923, 1923-1934, 1935-1946, and after 1946) and four survey periods (1965-1972, 1973-1978, 1979-1984, and 1985-1990). In the age-cohort model, the decrement in forced expiratory volume in 1 second (FEV1) associated with a yearly increase in age was 28.3 +/- 3.7 ml/year for a man 176 cm tall and 16.0 +/- 1.9 ml/year for a woman 163 cm tall. The estimated acceleration of decline with aging was significant for both men (beta = -0.212; standard error = 0.079 ml) and women (beta = -0.346; standard error = 0.058 ml). Compared with that of the cohort born before 1923, the average level of FEV1 was estimated to increase by 156, 277, and 379 ml, respectively, for the three younger cohorts in men (p = 0.01) and by 133, 213, and 328 ml for the three younger cohorts in women (p < 0.01). In the age-period model, the estimated linear age effect on FEV1 was 36.2 +/- 4.2 ml/year for a man and 30.5 +/- 2.3 ml/year for a woman. The age quadratic term was significant for women, but not for men. Average FEV1 was estimated to be increased by 141, 169, and 250 ml, respectively, for the periods 1973-1978, 1979-1984, and 1985-1990 in men and by 131, 138, and 219 ml in women. These period effects were significant for both men and women. In summary, this study applied the two-factor models to estimate cross-sectional and longitudinal effects of aging on FEV1 and demonstrated significant period and cohort effects, which could be attributed in part to changes in air pollutants, respiratory infections, vaccinations, types of cigarettes, diet, and lifestyles over time.