European Journal of Epidemiology

, Volume 27, Issue 12, pp 933-943

First online:

Combined effect of lung function level and decline increases morbidity and mortality risks

  • Penelope BaughmanAffiliated withDivision of Respiratory Disease Studies, Surveillance Branch, National Institute for Occupational Safety and Health Email author 
  • , Jacob L. MarottAffiliated withBispebjerg University Hospital
  • , Peter LangeAffiliated withDepartment of Public Health, Section of Social Medicine, Copenhagen University
  • , Christopher J. MartinAffiliated withDepartment of Community Medicine, Institute of Occupational and Environmental Health, West Virginia University
  • , Anoop ShankarAffiliated withDepartment of Community Medicine, West Virginia University
  • , Edward L. PetsonkAffiliated withDepartment of Medicine, Pulmonary and Critical Care Medicine, West Virginia University
  • , Eva HnizdoAffiliated withDivision of Respiratory Disease Studies, Surveillance Branch, National Institute for Occupational Safety and Health

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Lung function level and decline are each predictive of morbidity and mortality. Evaluation of the combined effect of these measurements may help further identify high-risk groups. Using Copenhagen City Heart Study longitudinal spirometry data (n = 10,457), 16–21 year risks of chronic obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease mortality, and all-cause mortality were estimated from combined effects of level and decline in forced expiratory volume in one second (FEV1). Risks were evaluated using Cox proportional hazards models for individuals grouped by combinations of baseline predicted FEV1 and quartiles of slope. Hazard ratios (HR) and 95 % confidence intervals (CI) were estimated using stratified analysis by gender, smoking status, and baseline age (≤45 and >45). For COPD morbidity, quartiles of increasing FEV1 decline increased HRs (95 % CI) for individuals with FEV1 at or above the lower limit of normal (LLN) but below 100 % predicted, reaching 5.11 (2.58–10.13) for males, 11.63 (4.75–28.46) for females, and 3.09 (0.88–10.86) for never smokers in the quartile of steepest decline. Significant increasing trends were also observed for mortality and in individuals with a baseline age ≤45. Groups with ‘normal’ lung function (FEV1 at or above the LLN) but excessive declines (fourth quartile of FEV1 slope) had significantly increased mortality risks, including never smokers and individuals with a baseline age ≤45.


Chronic obstructive pulmonary disease Morbidity Mortality Respiratory symptoms Spirometry