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EBioMedicine. 2019 Sep;47:58-64. doi: 10.1016/j.ebiom.2019.08.058. Epub 2019 Sep 5.

Determinants of impaired lung function and lung cancer prediction among never-smokers in the UK Biobank cohort.

Author information

1
Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 60 Murray Street, M5T 3L9 Toronto, ON, Canada; Dalla Lana School of Public Health, Department of Public Health Sciences, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON, Canada.
2
Department of Respiratory Medicine, Department of Medicine, University of British Columbia, 2775 Laurel Street, 7th floor, Vancouver V5Z 1M9, British Columbia, Canada; British Columbia Cancer Agency, 600 W 10th Ave, V5Z 4E6 Vancouver, British Columbia, Canada.
3
Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 60 Murray Street, M5T 3L9 Toronto, ON, Canada; Dalla Lana School of Public Health, Department of Public Health Sciences, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON, Canada. Electronic address: Rayjean.Hung@lunenfeld.ca.

Abstract

BACKGROUND:

Impaired lung health represents a significant burden on global health, including chronic obstructive pulmonary disease (COPD) and lung cancer. Given its global health impact, it is important to understand the determinants of impaired lung function and its relation to lung cancer risk independent of smoking. However, to date, no study has evaluated determinants of impaired lung function in a cohort exclusively of never-smokers, who also represent a growing proportion of all lung cancers.

METHODS:

A total of 222,274 never-smokers with reproducible spirograms were identified in the UK Biobank population-based cohort and included in the analysis. Baseline volumetric measures of lung function, including forced expiratory volume in 1-s (FEV1) and forced vital capacity (FVC), were used to define lung function impairment. Determinants of impaired lung function were evaluated using Poisson regression with robust variance estimation. The added value of lung function in lung cancer prediction was evaluated using Fine and Gray regression accounting for the competing risk of all-cause mortality.

FINDINGS:

Lung function impairment was associated with low birthweight, ambient air pollution (PM2·5 μg/mm3), and overweight, after adjustment for other important risk factors. We observed modest improvement in discrimination by adding lung function to our lung cancer prediction model for never-smokers. The highest optimism-corrected AUC at 3 (0·700, 95% CI: 0·654-0·734) and 5 years (0·694, 95% CI: 0·658-0·736) included FEV1 (% of GLI predicted FEV1), while the highest AUC at 7 years was based on the inclusion of FEV1/FVC (0·722, 95% CI: 0·687-0·762).

INTERPRETATION:

We identified several modifiable risk factors associated with increased risk of lung function impairment among lifetime never-smokers in UKB. We achieved moderate discrimination for lung cancer risk-prediction for never-smokers, and found modest improvement with the inclusion of lung function. FUND: This study was supported by a Canada Research Chair to RJH.

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