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Veenstra M, Lie Selle M, Johannessen A, Gulsvik A, Stavem K. Occupational class inequalities in all-cause and cardiovascular mortality in Norwegian men and women: a population-based approach with 45 years follow-up. Public Health 2024; 236:230-238. [PMID: 39276561 DOI: 10.1016/j.puhe.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES This study assessed associations of three theoretically different occupational class schemes with all-cause and cardiovascular mortality in Norwegian men and women. STUDY DESIGN Pooled survey and register data from four Norwegian cohort studies. METHODS We pooled survey data from four general population cohorts (N = 97,469) linked to national mortality registries with follow-up over 45 years. Survival was modelled using accelerated failure time models stratified by sex for three class schemes: The European Socio-Economic Classification (ESeC), The Oslo Register Data Class scheme (ORDC) and The International Socio-Economic Index (ISEI). Main analyses were adjusted for age, birth cohort, and study. Secondary analyses included smoking behaviour as a mediator. RESULTS During median 27.6 years of observation, 37,488 participants had died (13,243 from cardiovascular disease). Hazard ratios for male all-cause mortality were lowest in the highest occupational class categories ORDC 2: 0.68 (0.65-0.72), ESeC 1: 0.76 (0.73-0.79) and ISEI 5th quintile: 0.80 (0.77-0.82) compared to working class reference categories. Female mortality risks were lowest for Cultural Lower Middle class ORDC 7: 0.84 (0.72-0.98), Small Employers and Self-employed ESeC4: 0.70 (0.50-0.97) and ISEI 5th quintile: 0.79 (0.70-0.90). Patterns for cardiovascular mortality were similar to all-cause mortality. Including smoking behaviour as a mediator attenuated associations, but overall mortality patterns according to occupational class remained unchanged. CONCLUSION The results underline that mortality inequalities do not simply consist of higher risks in the most disadvantaged groups. The association of occupational class with mortality is found across different categories of occupational class schemes, illustrating their continued relevance for studying social determinants of health.
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Affiliation(s)
- M Veenstra
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
| | - M Lie Selle
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - A Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - A Gulsvik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - K Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Cestelli L, Stavem K, Johannessen A, Gulsvik A, Nielsen R. Outcome-based Definition of the Lower Limit of Normal in Spirometry: A Study of 26,000 Young Adult Men. Ann Am Thorac Soc 2024; 21:1261-1271. [PMID: 38656819 DOI: 10.1513/annalsats.202312-1027oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
Rationale: The definition of the lower limit of normal (LLN) of spirometric variables is not well established. Objectives: To investigate the relationship between spirometric abnormalities defined with different thresholds of the LLN and clinical outcomes and to explore the possibility of using different LLN thresholds according to the pretest probability of disease. Methods: We studied the associations between prebronchodilator spirometric abnormalities (forced expiratory volume in the first second [FEV1] < LLN, forced vital capacity [FVC] < LLN, airflow obstruction, spirometric restriction) defined with different thresholds of the LLN (10th, 5th, 2.5th, 1st percentile) and multiple outcomes (prevalence of spirometric abnormalities, respiratory symptoms, all-cause and respiratory mortality) in 26,091 30- to 46-year-old men who participated in a general population survey in Norway in 1988-1990 and were followed for 26 years. Analyses were performed with both local and Global Lung Function Initiative (GLI)-2012 reference equations, stratified by pretest risk (presence or absence of respiratory symptoms), and adjusted for age, body mass index, smoking, and education. Results: In the total population, the prevalence of airflow obstruction was 11.6% with GLI-LLN10, 11.0% with Local-LLN5, 6.1% with GLI-LLN5, 7.6% with Local-LLN2.5, and 3.5% with GLI-LLN2.5. The prevalence of spirometric restriction was 5.9% with GLI-LLN10, 5.2% with Local-LLN5, and 2.8% with GLI-LLN5. Increasingly lower thresholds of the LLN were associated with increasingly higher odds of respiratory symptoms and hazard of mortality for all spirometric abnormalities with both reference equations. Spirometric abnormalities defined with Local-LLN2.5 in asymptomatic subjects were associated with lower hazard of all-cause mortality (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.15-1.95 for FEV1 < LLN) than those defined with Local-LLN5 in the general population (HR, 1.67; 95% CI, 1.50-1.87 for FEV1 < LLN) and symptomatic subjects (HR, 1.67; 95% CI, 1.46-1.91 for FEV1 < LLN). Overall, the prevalence of spirometric abnormalities and associations with outcomes obtained with Local-LLN5 were comparable to those obtained with GLI-LLN10 and those obtained with Local-LLN2.5 to GLI-LLN5. Conclusions: There is a relationship between statistically based thresholds of the LLN of spirometric variables and clinical outcomes. Different thresholds of the LLN may be used in different risk subgroups of subjects, but the choice of the threshold needs to be evaluated together with the choice of reference equations.
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Affiliation(s)
| | - Knut Stavem
- Pulmonary Department and
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; and
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Rune Nielsen
- Department of Clinical Science and
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Cestelli L, Johannessen A, Gulsvik A, Stavem K, Nielsen R. Risk Factors, Morbidity, and Mortality in Association With Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern: Clinical Relevance of Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern. Chest 2024:S0012-3692(24)05078-5. [PMID: 39209063 DOI: 10.1016/j.chest.2024.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are often considered interchangeable in identifying restrictive impairment in spirometry. RESEARCH QUESTION Do PRISm and RSP have different individual associations with risk factors, morbidity, and mortality? STUDY DESIGN AND METHODS In a cross-sectional and longitudinal study, including 26,091 Norwegian general population men (30 to 46 years of age), we explored the association of PRISm and RSP with smoking habits, BMI, education, respiratory symptoms, self-reported cardiopulmonary disease, and mortality after 26 years of follow-up. PRISm was defined as FEV1/FVC ≥ lower limit of normal (LLN) and FEV1 < LLN, and RSP was defined as FEV1/FVC ≥ LLN and FVC < LLN. We compared the associations of PRISm and RSP to airflow obstruction and normal spirometry, both as mutually (PRISm alone, RSP alone) and nonmutually exclusive (PRISm, RSP) categories, adjusting for age, BMI, smoking, and education. We also conducted sensitivity analyses using Global Initiative for Chronic Obstructive Lung Disease criteria to define spirometric abnormalities. RESULTS The prevalence of the mutually exclusive spirometric patterns was as follows: normal 82.4%, obstruction 11.0%, PRISm alone 1.4%, RSP alone 1.7%, and PRISm + RSP 3.5%. PRISm alone patients were frequently obese (11.2%), had active or previous tobacco use, commonly reporting cough, phlegm, wheeze, asthma, and bronchitis. RSP alone patients were both obese (14.6%) and underweight (2.9%), with increased breathlessness, but similar smoking habits to patients with normal spirometry. The prevalence of heart disease was 4.6% in PRISm alone, 2.7% in RSP alone, and 1.6% in obstruction. With normal spirometry as a reference, RSP alone had increased all-cause (hazard ratio [HR], 1.57; 95% CI, 1.21-2.04), cardiovascular (HR, 1.48; 95% CI, 0.88-2.48), diabetes (HR, 6.43; 95% CI, 1.88-21.97), and cancer (excluding lung) mortality (HR, 1.51; 95% CI, 0.95-2.42). PRISm alone had increased respiratory disease mortality (HR, 4.00; 95% CI, 1.22-13.16). Patients with PRISm + RSP had intermediate characteristics and the worst prognosis. Findings were overall confirmed with nonmutually exclusive categories and Global Initiative for Chronic Obstructive Lung Disease criteria. INTERPRETATION PRISm and RSP are spirometric patterns with distinct risk factors, morbidity, and mortality, which should be differentiated in future studies.
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Affiliation(s)
- Lucia Cestelli
- Departments of Clinical Science, University of Bergen, Bergen.
| | - Ane Johannessen
- Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Departments of Clinical Science, University of Bergen, Bergen
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Rune Nielsen
- Departments of Clinical Science, University of Bergen, Bergen; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Cestelli L, Gulsvik A, Johannessen A, Stavem K, Nielsen R. Reduced lung function and cause-specific mortality: A population-based study of Norwegian men followed for 26 years. Respir Med 2023; 219:107421. [PMID: 37776914 DOI: 10.1016/j.rmed.2023.107421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND AND AIM Reduced lung function is associated with increased mortality, but it is unclear how different spirometric patterns are related to specific deaths. Aim of this study was to investigate these associations in a large general population cohort. METHODS The study population consisted of 26,091 men aged 30-46 years from the Pneumoconiosis Survey of Western Norway conducted in 1988-1990 with follow-up on date and cause of death for 26 years. Cox proportional hazard models were used to estimate the association between baseline FEV1, FVC, obstructive (OSP) and restrictive spirometric pattern (RSP) (z-scores calculated according to GLI-2012 equations) and mortality (European 2012 shortlist classification (E-2012)), after adjustment for age, body mass index, smoking habits, and education. RESULTS In total, 2462 (9%) subjects died. A predominant reduction of FEV1 (and OSP) were associated with respiratory non-cancer (E-8) (HR for one unit FEV1 z-score decrease 2.29 (95% CI 1.90, 2.77) and lung cancer mortality (E-2.1.8) (1.27(1.12, 1.44)). A similar reduction of FEV1 and FVC (and RSP) were associated with diabetes (E-4.1) (FEV1 2.21(1.67, 2.92), FVC 2.41(1.75, 3.32)), cerebrovascular (E-7.3) (1.52(1.21, 1.91), 1.54(1.19, 1.98)), ischemic heart disease (E-7.1) (1.22(1.10, 1.35), 1.21(1.08, 1.36)), neurological (E-6.3) (1.56(1.21, 2.01), 1.61(1.22, 2.13)), suicide (E-17.2) (1.37(1.13, 1.65), 1.29(1.04, 1.59)) and hematological cancer mortality (E-2.1.19-21) (1.29(1.05, 1.58), (1.26(1.00, 1.58)). No association was found between reduced lung function and mortality due to accidents, alcohol abuse, digestive and genitourinary cancer. CONCLUSIONS Spirometric obstruction was mainly related to pulmonary mortality. Spirometric restriction was mainly related to extra-pulmonary mortality.
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Affiliation(s)
- Lucia Cestelli
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Slåstad S, Von Hirsch Svendsen K, Langhammer A. Airway Symptoms among Farmers in Central Norway. A Comparative Study of Risks. The HUNT Study. J Agromedicine 2023; 28:300-308. [PMID: 36239019 DOI: 10.1080/1059924x.2022.2134245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The objective of this study was to compare the risk of developing respiratory symptoms in farmers and other occupational groups over a period of 11 to 23 years. METHODS The study includes data from questionnaires and interviews in HUNT1-3 in The Trøndelag Health study (HUNT). In all three surveys, farmers can be identified. Two control groups are used. Control group 1 consists of all HUNT participants who are not farmers or fishermen. Control group 2 consists of occupational groups who presumably have low exposure to dust, chemicals or gases, but similar educational status as farmers. The data are analysed in SPSS 25 (IBM, Armonk NY), with use of frequency analyses and multiple binary logistic regressions. RESULTS Our main finding is that healthy farmers have increased risk of developing respiratory symptoms as wheezing or breathlessness over a period of 11 and 23 years. This increased risk is statistically significant after 11 years of follow-up (HUNT1 to HUNT2), and also after 23 years (HUNT1 to HUNT3). Corresponding results regarding wheezing and breathlessness are found for healthy farmers in HUNT2 after 12 years of follow-up in HUNT3. In a subgroup analysis, we find a highly significant difference in both wheezing and shortness of breath when at work, in believing that the symptoms are caused by work, and in having to change jobs or quit because of breathing problems. CONCLUSION Farmers have more respiratory symptoms than controls, and the main symptom is attacks of wheezing or breathlessness. Preventive measures such as ventilation and respiratory protection should be implemented on the farm.
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Affiliation(s)
- Siri Slåstad
- Department of Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
| | | | - Arnulf Langhammer
- HUNT Research Centre, University of Science and Technology (NTNU), Levanger, Norway
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Cestelli L, Johannessen A, Stavem K, Gulsvik A, Nielsen R. Period and cohort effects: consequences on spirometric lung function in Norway during the 20th century. ERJ Open Res 2022; 8:00302-2022. [PMID: 36655225 PMCID: PMC9835971 DOI: 10.1183/23120541.00302-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/16/2022] [Indexed: 02/01/2023] Open
Abstract
Background and aim Several factors can influence measured lung function over time. The aim of this study was to investigate period and cohort effects on spirometric measures in a large general population sample in Norway during the 20th century, using Global Lung Function Initiative (GLI-2012) equations as a reference. Methods 36 466 subjects (born 1894-1969) from four cross-sectional surveys conducted between 1965 and 1999 were included, with harmonised data on smoking habits, respiratory symptoms, lung diseases, education and spirometry. Changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) z-scores in healthy subjects across surveys were explored to investigate period effects. Linear mixed-effects models of FEV1 and FVC z-scores on birth cohort, with survey as random effect, were used to investigate cohort effects, both in subjects of the total population and in healthy ones. Results Relatively higher FEV1 and FVC z-scores in healthy subjects were found in the first survey (1965-1970) compared to the more recent ones (1988-1999), suggesting period effects. FEV1 and FVC z-scores increased significantly with birth cohort from 1894 to 1935, after adjustment for covariates. A more stable trend of FEV1 and FVC z-scores with birth cohort was evidenced for subjects born more recently (1945-1969). Conclusions An increase of lung function with year of birth was observed in Norwegian subjects during the first half of the 20th century. The impact of period effects on lung function decreased from 1965 to 1999.
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Affiliation(s)
- Lucia Cestelli
- Department of Clinical Science, University of Bergen, Bergen, Norway,Corresponding author: Lucia Cestelli ()
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Stavem K, Schirmer H, Gulsvik A. Respiratory symptoms and cardiovascular causes of deaths: A population-based study with 45 years of follow-up. PLoS One 2022; 17:e0276560. [PMID: 36264870 PMCID: PMC9584444 DOI: 10.1371/journal.pone.0276560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
This study determined the association between respiratory symptoms and death from cardiovascular (CV) diseases during 45 years in a pooled sample of four cohorts of random samples of the Norwegian population with 95,704 participants. Respiratory symptoms were assessed using a modification of the MRC questionnaire on chronic bronchitis. We analyzed the association between respiratory symptoms and specific cardiovascular deaths by using Cox regression analysis with age as the time variable, accounting for cluster-specific random effects using shared frailty for study cohort. Hazard ratios (HR) for death were adjusted for sex, highest attained education, smoking habits, occupational air pollution, and birth cohort. Overall, 12,491 (13%) of participants died from CV diseases: 4,123 (33%) acute myocardial infarction, 2,326 (18%) other ischemic heart disease, 2,246 (18%) other heart diseases, 2,553 (20%) cerebrovascular diseases, and 1,120 (9%) other vascular diseases. The adjusted HR (95% confidence interval) for CV deaths was 1.9 (1.7–2.1) in men and 1.5 (1.2–1.9) in women for “yes” to the question “Are you breathless when you walk on level ground at an ordinary pace?”. The same item response showed an adjusted HR for death from acute myocardial infarction of 1.8 (1.5–2.1), other ischemic heart disease 2.2 (1.8–2.7), other heart diseases 1.5 (1.1–1.9), cerebrovascular disease 1.8 (1.5–2.3), and other circulatory diseases 1.7 (1.2–2.4). The adjusted HR for CV death was 1.3 (1.2–1.4) when answering positive to the question” Are you more breathless than people of your own age when walking uphill?”. However, positive answers to questions on cough, phlegm, wheezing and attacks of breathlessness were after adjustments not associated with early CV deaths. The associations between CV deaths and breathlessness were also present in never smokers. Self-reported breathlessness was associated with CV deaths and could be an early marker of CV deaths.
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Affiliation(s)
- Knut Stavem
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- * E-mail:
| | - Henrik Schirmer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Amund Gulsvik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Stavem K, Johannessen A, Nielsen R, Gulsvik A. Respiratory symptoms and respiratory deaths: A multi-cohort study with 45 years observation time. PLoS One 2021; 16:e0260416. [PMID: 34807953 PMCID: PMC8608323 DOI: 10.1371/journal.pone.0260416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
This study determined the association between respiratory symptoms and death from respiratory causes over a period of 45 years. In four cohorts of random samples of Norwegian populations with 103,881 participants, 43,731 persons had died per 31 December 2016. In total, 5,949 (14%) had died from respiratory diseases; 2,442 (41%) from lung cancer, 1,717 (29%) chronic obstructive pulmonary disease (COPD), 1,348 (23%) pneumonia, 119 (2%) asthma, 147 (2%) interstitial lung disease and 176 (3%) other pulmonary diseases. Compared with persons without respiratory symptoms the multivariable adjusted hazard ratio (HR) for lung cancer deaths increased with score of breathlessness on effort and cough and phlegm, being 2.6 (95% CI 2.1–3.2) for breathlessness score 3 and 2.1 (95% CI 1.7–2.5) for cough and phlegm score 5. The HR of COPD death was 6.4 (95% CI 5.4–7.7) for breathlessness score 3 and 3.0 (2.4–3.6) for cough and phlegm score 5. Attacks of breathlessness and wheeze score 2 had a HR of 1.6 (1.4–1.9) for COPD death. The risk of pneumonia deaths increased also with higher breathlessness on effort score, but not with higher cough and phlegm score, except for score 2 with HR 1.5 (1.2–1.8). In this study with >2.4 million person-years at risk, a positive association was observed between scores of respiratory symptoms and deaths due to COPD and lung cancer. Respiratory symptoms are thus important risk factors, which should be followed thoroughly by health care practitioners for the benefit of public health.
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Affiliation(s)
- Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- * E-mail:
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Puddu PE, Menotti A, Kromhout D, Kafatos A, Tolonen H. Chronic bronchitis in the 50-year follow-up of the European cohorts of the Seven Countries Study: prevalence, mortality and association with cardiovascular diseases. Respir Med 2021; 181:106385. [PMID: 33848923 DOI: 10.1016/j.rmed.2021.106385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/07/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To study prevalence of chronic bronchitis (CB) in residential populations and its relationship with mortality in a 50-year follow-up. MATERIAL AND METHODS In the late 1950's-early 1960's, 7047 men aged 40-59 years were enrolled in 10 European cohorts of the Seven Countries Study (in Finland, the Netherlands, Italy, Serbia and Greece). After baseline examination, follow-up for mortality was extended during 50 years (45 year in the Serbian cohorts). Prevalence of CB, and 50-year mortality from CB and other major causes of death were used as end-points to identify their determinants using multivariate models. RESULTS Prevalence of CB was directly associated with smoking habits and inversely associated with high socio-economic status (SES), forced expiratory volume in ¾ sec (FEV) and the ratio FEV/vital capacity (VC). Fifty-year mortality from CB was directly predicted by CB prevalence (from a minimum hazard ratio [HR] 2.35, 95% confidence limits [CI] 1.70-3.24, to a maximum HR 3.01, CI 2.18-5.20, depending on diagnostic criteria and different models) and age, and inversely by high SES, FEV and FEV/VC. The same applied in models predicting mortality from coronary heart disease (HR for prevalent CB: 1.53, CI 1.24-1.88), major cardiovascular diseases (HR 1.43, CI 1.23-1.67) and all-cause mortality (HR 1.48, CI 1.34-1.64) all adjusted for age, high SES, smoking habits and FEV. CONCLUSIONS CB is strongly associated with major cardiovascular disease and all-cause mortality while FEV and FEV/VC seem to carry at least partly an independent role from CB in predicting long-term mortality.
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Affiliation(s)
- Paolo Emilio Puddu
- EA 4650, Signalisation, électrophysiologie et Imagerie des Lésions D'ischémie Reperfusion Myocardique, UNICAEN, Caen, France; Association for Cardiac Research, Rome, Italy.
| | | | - Daan Kromhout
- Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Anthony Kafatos
- Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Hanna Tolonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
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Respiratory symptoms and mortality in four general population cohorts over 45 years. Respir Med 2020; 170:106060. [PMID: 32843179 DOI: 10.1016/j.rmed.2020.106060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study assessed the association between respiratory symptoms and mortality in four cohorts of the general population in Norway aged 15-75 years and in selected subgroups in the pooled sample. METHODS The study comprised 158,702 persons, who were drawn randomly from the Norwegian population register. All subjects received a standardized, self-administered questionnaire on 11 respiratory symptoms between 1972 and 1998, with follow-up of death until December 31, 2017. Analyses were performed on 114,380 respondents. RESULTS The hazard of death was closely associated with sex, age, and education. The hazard ratios (HR) for death and the 95% confidence intervals (CI) by risk factors were similar in the four cohorts. After adjustment for demographic and environmental, modifiable factors, the HR for death was 1.90 (95% CI 1.80-2.00) for breathlessness score 3, 1.28 (1.21-1.37) for cough/phlegm score 5 and 1.09 (1.05-1.14) for attack of breathlessness/wheeze score 2 compared to the referent (no symptom), respectively. The cough/phlegm score was associated with death in current smokers but not in never smokers or ex-smokers. Breathlessness score was associated with death in men and women. CONCLUSION Among persons aged 45-75 years, respiratory symptoms were significant predictors of all cause mortality. Education and smoking habits influenced only the associations between coughing and mortality. The associations were independent of study sites.
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Martinsen EMH, Eagan TML, Leiten EO, Nordeide E, Bakke PS, Lehmann S, Nielsen R. Motivation and response rates in bronchoscopy studies. Multidiscip Respir Med 2019; 14:14. [PMID: 31069076 PMCID: PMC6495518 DOI: 10.1186/s40248-019-0178-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/05/2019] [Indexed: 01/18/2023] Open
Abstract
Background Bronchoscopy is frequently used to sample the lower airways in lung microbiome studies. Despite being a safe procedure, it is associated with discomfort that may result in reservations regarding participation in research bronchoscopy studies. Information on participation in research bronchoscopy studies is limited. We report response rates, reasons for non-response, motivation for participation, and predictors of participation in a large-scale single-centre bronchoscopy study (“MicroCOPD”). Methods Two hundred forty-nine participants underwent at least one bronchoscopy in addition to being examined by a physician, having lung function tested, and being offered a CT scan of the heart and lungs (subjects > 40 years). Each participant was asked an open question regarding motivation. Non-response reasons were gathered, and response rates were calculated. Results The study had a response rate just above 50%, and men had a significantly higher response rate than women (56.5% vs. 44.8%, p = 0.01). Procedural fear was the most common non-response reason. Most participants participated due to perceived personal benefit, but a large proportion did also participate to help others and contribute to science. Men were less likely to give exclusive altruistic motives, whereas subjects with asthma were more likely to report exclusive personal benefit as main motive. Conclusion Response rates of about 50% in bronchoscopy studies make large bronchoscopy studies feasible, but the fact that participants are motivated by their own health status places a large responsibility on the investigators regarding the accuracy of the provided study information. Electronic supplementary material The online version of this article (10.1186/s40248-019-0178-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Einar M H Martinsen
- 1Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Tomas M L Eagan
- 1Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway.,2Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Elise O Leiten
- 1Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Eli Nordeide
- 2Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Per S Bakke
- 1Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Sverre Lehmann
- 1Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway.,2Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Rune Nielsen
- 1Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway.,2Department of Thoracic Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
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Gulsvik AK, Henriksen AH, Svendsen E, Humerfelt S, Gulsvik A. Validity of the European short list of respiratory diseases: a 40-year autopsy study. Eur Respir J 2014; 45:953-61. [PMID: 25359344 DOI: 10.1183/09031936.00085214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The predictors of autopsy and the accuracy of European short list (E) codes of respiratory diseases lack recent knowledge. A 10% random sample (n=6811) of inhabitants of Bergen, Norway, aged 20-70 years, was invited to participate in a survey in 1965-1971 (participation rate 83%). By December 31, 2005, 4387 (64%) participants had died and 1163 (27% of the deceased) had been given an autopsy. Causes of death were tuberculosis (E02, 0.2%), lung malignancy (E15, 3.5%), influenza (E38, 0.2%), pneumonia (E39, 6.5%) and chronic lower respiratory diseases (E40, 3.2%). Male sex, early deaths in the surveillance period and E15 were positive predictors of an autopsy examination, whereas old age and E39 were strong negative predictors. Among those referred for a post mortem examination, the cause of death was verified as tuberculosis in 0.3%, lung cancer in 8.1%, acute pneumonia in 2.0% and chronic obstructive lung diseases in 4.9%. Cohen's kappa coefficients (E codes versus autopsy) were 0.91 (95% CI 0.86-0.96) for E15, 0.37 (95% CI 0.20-0.54) for E39 and 0.65 (95% CI 0.54-0.76) for E40. These findings matter when deaths from respiratory diseases are used as end-points in epidemiological association studies and clinical trials.
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Affiliation(s)
| | - Andreas H Henriksen
- Section of Thoracic Medicine, Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Einar Svendsen
- Dept of Pathology, The Gade Institute, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Sjur Humerfelt
- Clinic of Allergology and Respiratory Medicine, Oslo, Norway
| | - Amund Gulsvik
- Section of Thoracic Medicine, Dept of Clinical Science, University of Bergen, Bergen, Norway
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Waatevik M, Skorge TD, Omenaas E, Bakke PS, Gulsvik A, Johannessen A. Increased prevalence of chronic obstructive pulmonary disease in a general population. Respir Med 2013; 107:1037-45. [DOI: 10.1016/j.rmed.2013.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 02/01/2023]
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Gulsvik AK, Thelle DS, Samuelsen SO, Myrstad M, Mowé M, Wyller TB. Ageing, physical activity and mortality—a 42-year follow-up study. Int J Epidemiol 2011; 41:521-30. [PMID: 22253311 DOI: 10.1093/ije/dyr205] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne K Gulsvik
- Department of Geriatric Medicine, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Norway.
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Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD. Pulm Med 2011; 2011:419328. [PMID: 21647214 PMCID: PMC3100107 DOI: 10.1155/2011/419328] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 12/13/2010] [Accepted: 12/15/2010] [Indexed: 11/17/2022] Open
Abstract
The objective of the present study was to determine the association between CT phenotypes-emphysema by low attenuation area and bronchitis by airway wall thickness-and body composition parameters in a large cohort of subjects with and without COPD. In 452 COPD subjects and 459 subjects without COPD, CT scans were performed to determine emphysema (%LAA), airway wall thickness (AWT-Pi10), and lung mass. Muscle wasting based on FFMI was assessed by bioelectrical impedance. In both the men and women with COPD, FFMI was negatively associated with %LAA. FMI was positively associated with AWT-Pi10 in both subjects with and without COPD. Among the subjects with muscle wasting, the percentage emphysema was high, but the predictive value was moderate. In conclusion, the present study strengthens the hypothesis that the subgroup of COPD cases with muscle wasting have emphysema. Airway wall thickness is positively associated with fat mass index in both subjects with and without COPD.
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Diagnostic validity of fatal cerebral strokes and coronary deaths in mortality statistics: an autopsy study. Eur J Epidemiol 2010; 26:221-8. [PMID: 21170572 PMCID: PMC3079075 DOI: 10.1007/s10654-010-9535-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 12/03/2010] [Indexed: 10/24/2022]
Abstract
Mortality statistics represent important endpoints in epidemiological studies. The diagnostic validity of cerebral stroke and ischemic heart disease recorded as the underlying cause of death in Norwegian mortality statistics was assessed by using mortality data of participants in the Bergen Clinical Blood Pressure Study in Norway and autopsy records from the Gade Institute in Bergen. In the 41 years of the study (1965-2005) 4,387 subjects had died and 1,140 (26%) had undergone a post mortem examination; 548 (12%) died from cerebral stroke and 1,120 (24%) from ischemic heart disease according to the mortality statistics, compared to 113 (10%) strokes and 323 (28%) coronary events registered in the autopsy records. The sensitivity and positive predictive value of fatal cerebral strokes in the mortality statistics were 0.75, 95% confidence interval (CI) [0.66, 0.83] and 0.86 [0.77, 0.92], respectively, whereas those of coronary deaths were 0.87 [0.84, 0.91] and 0.85 [0.81, 0.89] respectively. Cohen's Kappa coefficients were 0.78 [0.72, 0.84] for stroke and 0.80 [0.76, 0.84] for coronary deaths. In addition to female gender and increasing age at death, cerebral stroke was a negative predictor of an autopsy being carried out (odds ratio (OR) 0.69, 95% CI [0.54, 0.87]), whereas death from coronary heart disease was not (OR 1.14, 95% CI [0.97, 1,33]), both adjusted for gender and age at death. There was substantial agreement between mortality statistics and autopsy findings for both fatal strokes and coronary deaths. Selection for post mortem examinations was associated with age, gender and cause of death.
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Gulsvik AK, Thelle DS, Mowé M, Wyller TB. Increased mortality in the slim elderly: a 42 years follow-up study in a general population. Eur J Epidemiol 2009; 24:683-90. [PMID: 19777355 DOI: 10.1007/s10654-009-9390-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 09/12/2009] [Indexed: 11/28/2022]
Abstract
The Bergen Clinical Blood Pressure Study in Norway was used to examine the relationship between body mass index (BMI (kg/m(2))) and total mortality in different age segments. Of 6,811 invited subjects, 5,653 (84%) participated in the study (1965-1971) and 4,520 (66%) died during 182,798 person-years of follow-up (1965-2007). Mean age at baseline was 47.5 years; range 22-75 years. BMI (kg/m(2)) was calculated from standardized measurements of body height and weight and divided into four groups (<22.0, 22.0-24.9, 25.0-27.9, > or =28.0). The 20 years cumulative risk of death related to baseline BMI was U-shaped in the elderly (aged 65-75 years), whereas the pattern was more linear in the youngest age group (20-44 years). In contrast to the younger age groups, the highest mortality in the elderly was in the lower BMI range (<22.0 kg/m(2)) (adjusted Cox proportional Hazard Ratio 1.39, 95% Confidence Interval 1.10, 1.75) compared to the BMI reference group (22.0-24.9 kg/m(2)). This pattern persisted after 72 months of early follow-up exclusion and it was robust to adjustments for a wide range of possible confounders including gender, history of cardiovascular disease, respiratory disease or hypertension, smoking habits, physical activity, socioeconomic status, physical appearance and other anthropometric measures. The study shows that a low BMI is an appreciable independent risk factor of total mortality in the elderly, and not a result of subclinical disease or confounding factors such as current or previous smoking. Awareness of this issue ought to be emphasized in advice, care and treatment of elderly subjects.
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Affiliation(s)
- Anne K Gulsvik
- Department of Geriatric Medicine, Ullevaal University Hospital, University of Oslo, 0407, Oslo, Norway.
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