Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies,The Lancet Respiratory Medicine

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Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies
The Lancet Respiratory Medicine ( IF 38.7 ) Pub Date : 2021-10-04 , DOI: 10.1016/s2213-2600(21)00313-1
James P Allinson ₁ , Shoaib Afzal ₂ , Yunus Çolak ₃ , Debbie Jarvis ₄ , Helena Backman ₅ , Maarten van den Berge ₆ , H Marike Boezen ₇ , Marie-Kathrin Breyer ₈ , Robab Breyer-Kohansal ₈ , Guy Brusselle ₉ , Otto C Burghuber ₁₀ , Rosa Faner ₁₁ , Sylvia Hartl ₁₂ , Lies Lahousse ₁₃ , Arnulf Langhammer ₁₄ , Bo Lundbäck ₁₅ , Bright I Nwaru ₁₆ , Eva Rönmark ₅ , Sigrid A Aalberg Vikjord ₁₇ , Judith M Vonk ₇ , Sara R A Wijnant ₁₈ , Peter Lange ₁₉ , Børge G Nordestgaard ₂ , Nuria Olvera ₁₁ , Alvar Agusti ₂₀ , Gavin C Donaldson ₄ , Jadwiga A Wedzicha ₄ , Jørgen Vestbo ₂₁ , Lowie E G W Vanfleteren ₂₂ ,

Affiliation

Department of Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
National Heart and Lung Institute, Imperial College London, London, UK.
Department of Public Health and Clinical Medicine, The OLIN Unit, Section of Sustainable Health, Umeå University, Umeå, Sweden.
Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria.
Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria.
Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain.
Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria.
Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Department of Medicine and Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.
Càtedra Salut Respiratòria, Universitat Barcelona, Spain; Respiratory Institute, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain.
Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; North West Lung Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; COPD Centre, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background

During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements.

Methods

In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20–94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV₁, forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV₁ and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV₁/FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV₁ and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year.

Findings

Across the ten included studies, we included 243 465 European participants (mean age 51·4 years, 95% CI 51·4–51·5) in our analysis, of whom 136 275 (56·0%) were female and 107 190 (44·0%) were male. After full adjustment, FEV₁ increased by 4·8 mL/birth year (95% CI 2·6–7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7–12·0; p<0·0001). Birth year-related increases in the FEV₁ and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV₁ and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV₁/FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09–0·14; p<0·0001).

Interpretation

If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity.

Funding

The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme.

中文翻译：

1884 年至 1996 年间出生的欧洲成年人肺功能的变化及其对肺病诊断的影响：十项基于人群的研究的横断面分析

背景

在过去的一个世纪里，社会经济和科学的进步导致欧洲人口的健康和体质发生了变化。伴随肺功能的改善，如果未被识别，可能会导致肺功能测量的错误分类和肺疾病的误诊。因此，我们调查了过去一个世纪人口肺功能随出生年份的变化，考虑了人口身高的增加，并研究了这些变化如何影响肺功能测量的解释。

方法

在我们对 10 项欧洲人群研究的横断面数据进行分析时，我们纳入了 1884 年至 1996 年间出生的 20-94 岁的个体，无论之前的呼吸道诊断或症状如何。在 1965 年至 2016 年期间测量了FEV ₁、用力肺活量 (FVC)、身高、体重和吸烟行为。我们使用元回归来研究 FEV ₁和 FVC（根据年龄、研究、身高、性别、吸烟状况、吸烟包年数和体重）和 FEV ₁/FVC 比率（根据年龄、研究、性别和吸烟状况进行调整）随出生年份而变化。使用这些模型的估计值，我们以图形方式探索了平均肺功能值将如何逐渐偏离预测值。为了证实我们的发现，我们使用线性回归来研究 1961 年至 2015 年间发布的 32 个参考方程预测的 FEV ₁和 FVC 值如何随估计的出生年份而变化。

发现

在纳入的十项研究中，我们纳入了 243 465 名欧洲参与者（平均年龄 51·4 岁，95% CI 51·4-51·5），其中 136 275 名（56·0%）为女性，107 190 名(44·0%)为男性。完全调整后，FEV ₁增加了 4·8 mL/出生年（95% CI 2·6-7·0；p<0·0001），FVC 增加了 8·8 mL/出生年（5·7-12 ·0；p<0·0001)。已发表的参考方程预测的 FEV ₁和 FVC 值与出生年份相关的增加证实了这些发现。_{上个世纪 FEV 1}和 FVC 的这种与身高无关的增加将导致平均人口值逐渐超过先前的预测值。然而，总体平均调整后的 FEV ₁/FVC 比率每 100 个出生年下降 0·11（95% CI 0·09–0·14；p<0·0001）。