Airway obstruction and mortality

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Background and aims: Subjects with chronic obstructive pulmonary disease (COPD) have comorbidities and increased mortality rate. However, a long-term follow-up data about COPD and mortality appear partly deficient. The aim of this study was to evaluate whether airway obstruction at baseline predicts acute myocardial infarction (MI) and coronary and all-cause mortality, and whether past pulmonary tuberculosis (TB) or low vitamin D status confound or modify the association between obstruction and mortality in 30 years´ follow-up. Methods: A national health examination survey, the Mini-Finland Health Survey performed in 1978–1980, collected data from 8000 subjects´ sample representing Finnish adult population. Studies I to IV included those 5576–6701 participants who had all necessary information, including spirometry, collected for each study. Obstruction was defined either with a fixed ratio of FEV1/FVC <0.7 or with FEV1/FVC below the lower limit of normal (LLN) categorization, and staged for severity by the Global Initiative for Chronic Obstructive Lung Disease classification (GOLD stages 1–4). Results: In follow-up, decreasing lung function had a strong significant association with all-cause mortality. Respectively HRs with 95% CIs in GOLD stages 1 to 4 were 1.27 (1.06–1.51), 1.40 (1.21–1.63), 1.55 (1.22–1.97), and 2.85 (1.65–4.94) compared to those with FEV1/FVC ≥ 0.7. The risk for cardiovascular mortality was consistently increased in GOLD stages 1–4 but no association emerged after those with a cardiovascular disease at baseline were excluded. Obstruction predicted all-cause mortality strongest in subjects aged 30–49 at baseline (study I). Obstruction predicted coronary mortality but not MI in those without a cardiovascular disease at baseline, respectively, HRs with 95% CIs in subjects with obstruction were 1.40 (1.04–1.88) and 0.84 (0.54–1.31) when compared to those without (study II). Obstruction and past pulmonary tuberculosis (TB), determined either as a TB disease history or a scar indicating it on chest x-ray, predicted all-cause mortality with an additive pattern in follow-up (study III). The association between a low vitamin D status and mortality was pronounced among subjects with obstruction (study IV). Conclusions: Airway obstruction predicts all-cause mortality by decreasing lung function, and mortality risk appear increased especially in the younger population with obstruction. Additionally, obstruction strongly determines coronary mortality but not MI. Obstruction and past TB have an additive effect on all-cause mortality. A low vitamin D status may be particularly detrimental among subjects with obstruction.
Original languageEnglish
Supervisors/Advisors
  • Vasankari, Tuula, Supervisor, External person
  • Heliövaara, Markku, Supervisor, External person
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4012-8
Electronic ISBNs978-951-51-4013-5
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Airway Obstruction
  • +epidemiology
  • +complications
  • +mortality
  • Tuberculosis, Pulmonary
  • Mortality, Premature
  • Vital Capacity
  • Vitamin D Deficiency
  • Sex Factors
  • Age Factors
  • Myocardial Infarction
  • Coronary Disease
  • Comorbidity
  • Mortality
  • Spirometry
  • Smoking
  • Adult
  • 3121 Internal medicine

Cite this

Mattila, T. (2018). Airway obstruction and mortality. Helsinki: Helsingin yliopisto.
Mattila, Tiina. / Airway obstruction and mortality. Helsinki : Helsingin yliopisto, 2018. 84 p.
@phdthesis{1e0c0564192a44f795234e811964520c,
title = "Airway obstruction and mortality",
abstract = "Background and aims: Subjects with chronic obstructive pulmonary disease (COPD) have comorbidities and increased mortality rate. However, a long-term follow-up data about COPD and mortality appear partly deficient. The aim of this study was to evaluate whether airway obstruction at baseline predicts acute myocardial infarction (MI) and coronary and all-cause mortality, and whether past pulmonary tuberculosis (TB) or low vitamin D status confound or modify the association between obstruction and mortality in 30 years´ follow-up. Methods: A national health examination survey, the Mini-Finland Health Survey performed in 1978–1980, collected data from 8000 subjects´ sample representing Finnish adult population. Studies I to IV included those 5576–6701 participants who had all necessary information, including spirometry, collected for each study. Obstruction was defined either with a fixed ratio of FEV1/FVC <0.7 or with FEV1/FVC below the lower limit of normal (LLN) categorization, and staged for severity by the Global Initiative for Chronic Obstructive Lung Disease classification (GOLD stages 1–4). Results: In follow-up, decreasing lung function had a strong significant association with all-cause mortality. Respectively HRs with 95{\%} CIs in GOLD stages 1 to 4 were 1.27 (1.06–1.51), 1.40 (1.21–1.63), 1.55 (1.22–1.97), and 2.85 (1.65–4.94) compared to those with FEV1/FVC ≥ 0.7. The risk for cardiovascular mortality was consistently increased in GOLD stages 1–4 but no association emerged after those with a cardiovascular disease at baseline were excluded. Obstruction predicted all-cause mortality strongest in subjects aged 30–49 at baseline (study I). Obstruction predicted coronary mortality but not MI in those without a cardiovascular disease at baseline, respectively, HRs with 95{\%} CIs in subjects with obstruction were 1.40 (1.04–1.88) and 0.84 (0.54–1.31) when compared to those without (study II). Obstruction and past pulmonary tuberculosis (TB), determined either as a TB disease history or a scar indicating it on chest x-ray, predicted all-cause mortality with an additive pattern in follow-up (study III). The association between a low vitamin D status and mortality was pronounced among subjects with obstruction (study IV). Conclusions: Airway obstruction predicts all-cause mortality by decreasing lung function, and mortality risk appear increased especially in the younger population with obstruction. Additionally, obstruction strongly determines coronary mortality but not MI. Obstruction and past TB have an additive effect on all-cause mortality. A low vitamin D status may be particularly detrimental among subjects with obstruction.",
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Airway obstruction and mortality. / Mattila, Tiina.

Helsinki : Helsingin yliopisto, 2018. 84 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Airway obstruction and mortality

AU - Mattila, Tiina

N1 - M1 - 84 s. + liitteet

PY - 2018

Y1 - 2018

N2 - Background and aims: Subjects with chronic obstructive pulmonary disease (COPD) have comorbidities and increased mortality rate. However, a long-term follow-up data about COPD and mortality appear partly deficient. The aim of this study was to evaluate whether airway obstruction at baseline predicts acute myocardial infarction (MI) and coronary and all-cause mortality, and whether past pulmonary tuberculosis (TB) or low vitamin D status confound or modify the association between obstruction and mortality in 30 years´ follow-up. Methods: A national health examination survey, the Mini-Finland Health Survey performed in 1978–1980, collected data from 8000 subjects´ sample representing Finnish adult population. Studies I to IV included those 5576–6701 participants who had all necessary information, including spirometry, collected for each study. Obstruction was defined either with a fixed ratio of FEV1/FVC <0.7 or with FEV1/FVC below the lower limit of normal (LLN) categorization, and staged for severity by the Global Initiative for Chronic Obstructive Lung Disease classification (GOLD stages 1–4). Results: In follow-up, decreasing lung function had a strong significant association with all-cause mortality. Respectively HRs with 95% CIs in GOLD stages 1 to 4 were 1.27 (1.06–1.51), 1.40 (1.21–1.63), 1.55 (1.22–1.97), and 2.85 (1.65–4.94) compared to those with FEV1/FVC ≥ 0.7. The risk for cardiovascular mortality was consistently increased in GOLD stages 1–4 but no association emerged after those with a cardiovascular disease at baseline were excluded. Obstruction predicted all-cause mortality strongest in subjects aged 30–49 at baseline (study I). Obstruction predicted coronary mortality but not MI in those without a cardiovascular disease at baseline, respectively, HRs with 95% CIs in subjects with obstruction were 1.40 (1.04–1.88) and 0.84 (0.54–1.31) when compared to those without (study II). Obstruction and past pulmonary tuberculosis (TB), determined either as a TB disease history or a scar indicating it on chest x-ray, predicted all-cause mortality with an additive pattern in follow-up (study III). The association between a low vitamin D status and mortality was pronounced among subjects with obstruction (study IV). Conclusions: Airway obstruction predicts all-cause mortality by decreasing lung function, and mortality risk appear increased especially in the younger population with obstruction. Additionally, obstruction strongly determines coronary mortality but not MI. Obstruction and past TB have an additive effect on all-cause mortality. A low vitamin D status may be particularly detrimental among subjects with obstruction.

AB - Background and aims: Subjects with chronic obstructive pulmonary disease (COPD) have comorbidities and increased mortality rate. However, a long-term follow-up data about COPD and mortality appear partly deficient. The aim of this study was to evaluate whether airway obstruction at baseline predicts acute myocardial infarction (MI) and coronary and all-cause mortality, and whether past pulmonary tuberculosis (TB) or low vitamin D status confound or modify the association between obstruction and mortality in 30 years´ follow-up. Methods: A national health examination survey, the Mini-Finland Health Survey performed in 1978–1980, collected data from 8000 subjects´ sample representing Finnish adult population. Studies I to IV included those 5576–6701 participants who had all necessary information, including spirometry, collected for each study. Obstruction was defined either with a fixed ratio of FEV1/FVC <0.7 or with FEV1/FVC below the lower limit of normal (LLN) categorization, and staged for severity by the Global Initiative for Chronic Obstructive Lung Disease classification (GOLD stages 1–4). Results: In follow-up, decreasing lung function had a strong significant association with all-cause mortality. Respectively HRs with 95% CIs in GOLD stages 1 to 4 were 1.27 (1.06–1.51), 1.40 (1.21–1.63), 1.55 (1.22–1.97), and 2.85 (1.65–4.94) compared to those with FEV1/FVC ≥ 0.7. The risk for cardiovascular mortality was consistently increased in GOLD stages 1–4 but no association emerged after those with a cardiovascular disease at baseline were excluded. Obstruction predicted all-cause mortality strongest in subjects aged 30–49 at baseline (study I). Obstruction predicted coronary mortality but not MI in those without a cardiovascular disease at baseline, respectively, HRs with 95% CIs in subjects with obstruction were 1.40 (1.04–1.88) and 0.84 (0.54–1.31) when compared to those without (study II). Obstruction and past pulmonary tuberculosis (TB), determined either as a TB disease history or a scar indicating it on chest x-ray, predicted all-cause mortality with an additive pattern in follow-up (study III). The association between a low vitamin D status and mortality was pronounced among subjects with obstruction (study IV). Conclusions: Airway obstruction predicts all-cause mortality by decreasing lung function, and mortality risk appear increased especially in the younger population with obstruction. Additionally, obstruction strongly determines coronary mortality but not MI. Obstruction and past TB have an additive effect on all-cause mortality. A low vitamin D status may be particularly detrimental among subjects with obstruction.

KW - Airway Obstruction

KW - +epidemiology

KW - +complications

KW - +mortality

KW - Tuberculosis, Pulmonary

KW - Mortality, Premature

KW - Vital Capacity

KW - Vitamin D Deficiency

KW - Sex Factors

KW - Age Factors

KW - Myocardial Infarction

KW - Coronary Disease

KW - Comorbidity

KW - Mortality

KW - Spirometry

KW - Smoking

KW - Adult

KW - 3121 Internal medicine

M3 - Doctoral Thesis

SN - 978-951-51-4012-8

T3 - Dissertationes Scholae Doctoralis Ad Sanitatem Investigandam Universitatis Helsinkiensis

PB - Helsingin yliopisto

CY - Helsinki

ER -

Mattila T. Airway obstruction and mortality. Helsinki: Helsingin yliopisto, 2018. 84 p. (Dissertationes Scholae Doctoralis Ad Sanitatem Investigandam Universitatis Helsinkiensis; 12/2018 ).