• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. May 2003; 58(5): 388–393.
PMCID: PMC1746680

Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study


Background: A study was undertaken to define the risk of death among a national cohort of US adults both with and without lung disease.

Methods: Participants in the first National Health and Nutrition Examination Survey (NHANES I) followed for up to 22 years were studied. Subjects were classified using a modification of the Global Initiative for Chronic Obstructive Lung Disease criteria for chronic obstructive pulmonary disease (COPD) into the following mutually exclusive categories using the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and the presence of respiratory symptoms: severe COPD, moderate COPD, mild COPD, respiratory symptoms only, restrictive lung disease, and no lung disease. Proportional hazard models were developed that controlled for age, race, sex, education, smoking status, pack years of smoking, years since quitting smoking, and body mass index.

Results: A total of 1301 deaths occurred in the 5542 adults in the cohort. In the adjusted proportional hazards model the presence of severe or moderate COPD was associated with a higher risk of death (hazard ratios (HR) 2.7 and 1.6, 95% confidence intervals (CI) 2.1 to 3.5 and 1.4 to 2.0), as was restrictive lung disease (HR 1.7, 95% CI 1.4 to 2.0).

Conclusions: The presence of both obstructive and restrictive lung disease is a significant predictor of earlier death in long term follow up.

Full Text

The Full Text of this article is available as a PDF (129K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001 Apr;163(5):1256–1276. [PubMed]
  • Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med. 2000 Jun 12;160(11):1683–1689. [PubMed]
  • Postma DS, Sluiter HJ. Prognosis of chronic obstructive pulmonary disease: the Dutch experience. Am Rev Respir Dis. 1989 Sep;140(3 Pt 2):S100–S105. [PubMed]
  • Neas LM, Schwartz J. Pulmonary function levels as predictors of mortality in a national sample of US adults. Am J Epidemiol. 1998 Jun 1;147(11):1011–1018. [PubMed]
  • Anthonisen NR. Prognosis in chronic obstructive pulmonary disease: results from multicenter clinical trials. Am Rev Respir Dis. 1989 Sep;140(3 Pt 2):S95–S99. [PubMed]
  • Hospers JJ, Postma DS, Rijcken B, Weiss ST, Schouten JP. Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study. Lancet. 2000 Oct 14;356(9238):1313–1317. [PubMed]
  • Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996 Sep 21;313(7059):711–716. [PMC free article] [PubMed]
  • Knuiman MW, James AL, Divitini ML, Ryan G, Bartholomew HC, Musk AW. Lung function, respiratory symptoms, and mortality: results from the Busselton Health Study. Ann Epidemiol. 1999 Jul;9(5):297–306. [PubMed]
  • Schünemann HJ, Dorn J, Grant BJ, Winkelstein W, Jr, Trevisan M. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest. 2000 Sep;118(3):656–664. [PubMed]
  • Cohen BB, Barbano HE, Cox CS, Feldman JJ, Finucane FF, Kleinman JC, Madans JH. Plan and operation of the NHANES I Epidemiologic Followup Study: 1982-84. Vital Health Stat 1. 1987 Jun;(22):1–142. [PubMed]
  • Cox CS, Mussolino ME, Rothwell ST, Lane MA, Golden CD, Madans JH, Feldman JJ. Plan and operation of the NHANES I Epidemiologic Followup Study, 1992. Vital Health Stat 1. 1997 Dec;(35):1–231. [PubMed]
  • Cox CS, Rothwell ST, Madans JH, Finucane FF, Freid VM, Kleinman JC, Barbano HE, Feldman JJ. Plan and operation of the NHANES I Epidemiologic Followup Study, 1987. Vital Health Stat 1. 1992 Sep;(27):1–190. [PubMed]
  • Finucane FF, Freid VM, Madans JH, Cox CS, Kleinman JC, Rothwell ST, Barbano HE, Feldman JJ. Plan and operation of the NHANES I Epidemiologic Followup Study, 1986. Vital Health Stat 1. 1990 Sep;(25):1–154. [PubMed]
  • O'Brien RJ, Drizd TA. Basic data on spirometry in adults 25-74 years of age: United States, 1971-75. Vital Health Stat 11. 1981 Mar;(222):1–36. [PubMed]
  • Burrows B, Bloom JW, Traver GA, Cline MG. The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med. 1987 Nov 19;317(21):1309–1314. [PubMed]
  • Engström G, Hedblad B, Janzon L, Valind S. Respiratory decline in smokers and ex-smokers--an independent risk factor for cardiovascular disease and death. J Cardiovasc Risk. 2000 Aug;7(4):267–272. [PubMed]
  • Ryan G, Knuiman MW, Divitini ML, James A, Musk AW, Bartholomew HC. Decline in lung function and mortality: the Busselton Health Study. J Epidemiol Community Health. 1999 Apr;53(4):230–234. [PMC free article] [PubMed]
  • Bang KM, Gergen PJ, Kramer R, Cohen B. The effect of pulmonary impairment on all-cause mortality in a national cohort. Chest. 1993 Feb;103(2):536–540. [PubMed]
  • Pelkonen M, Tukiainen H, Tervahauta M, Notkola IL, Kivelä SL, Salorinne Y, Nissinen A. Pulmonary function, smoking cessation and 30 year mortality in middle aged Finnish men. Thorax. 2000 Sep;55(9):746–750. [PMC free article] [PubMed]
  • Sharp DS, Masaki K, Burchfiel CM, Yano K, Schatz IJ. Prolonged QTc interval, impaired pulmonary function, and a very lean body mass jointly predict all-cause mortality in elderly men. Ann Epidemiol. 1998 Feb;8(2):99–106. [PubMed]
  • Stewart AG, Waterhouse JC, Howard P. The QTc interval, autonomic neuropathy and mortality in hypoxaemic COPD. Respir Med. 1995 Feb;89(2):79–84. [PubMed]
  • Volterrani M, Scalvini S, Mazzuero G, Lanfranchi P, Colombo R, Clark AL, Levi G. Decreased heart rate variability in patients with chronic obstructive pulmonary disease. Chest. 1994 Nov;106(5):1432–1437. [PubMed]
  • Maltais F, LeBlanc P, Jobin J, Casaburi R. Peripheral muscle dysfunction in chronic obstructive pulmonary disease. Clin Chest Med. 2000 Dec;21(4):665–677. [PubMed]
  • Rahman I, MacNee W. Oxidant/antioxidant imbalance in smokers and chronic obstructive pulmonary disease. Thorax. 1996 Apr;51(4):348–350. [PMC free article] [PubMed]
  • Repine JE, Bast A, Lankhorst I. Oxidative stress in chronic obstructive pulmonary disease. Oxidative Stress Study Group. Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):341–357. [PubMed]
  • Camilli AE, Robbins DR, Lebowitz MD. Death certificate reporting of confirmed airways obstructive disease. Am J Epidemiol. 1991 Apr 15;133(8):795–800. [PubMed]
  • Hunt LW, Jr, Silverstein MD, Reed CE, O'Connell EJ, O'Fallon WM, Yunginger JW. Accuracy of the death certificate in a population-based study of asthmatic patients. JAMA. 1993 Apr 21;269(15):1947–1952. [PubMed]
  • Aaron SD, Dales RE, Cardinal P. How accurate is spirometry at predicting restrictive pulmonary impairment? Chest. 1999 Mar;115(3):869–873. [PubMed]
  • Ferguson GT, Enright PL, Buist AS, Higgins MW. Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program. Chest. 2000 Apr;117(4):1146–1161. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...