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Pooled Cohort Probability Score for Subclinical Airflow Obstruction.

Monday,2022-10-10 13:18 America/Los_Angeles — ecterry
TitlePooled Cohort Probability Score for Subclinical Airflow Obstruction.
Publication TypeJournal Article
Year of Publication2022
AuthorsBhatt, SP, Balte, PP, Schwartz, JE, Jaeger, BC, Cassano, PA, Chaves, PH, Couper, D, Jacobs, DR, Kalhan, R, Kaplan, R, Lloyd-Jones, D, Newman, AB, O'Connor, G, Sanders, JL, Smith, BM, Sun, Y, Umans, JG, White, WB, Yende, S, Oelsner, EC
JournalAnn Am Thorac Soc
Volume19
Issue8
Pagination1294-1304
Date Published2022 08
ISSN2325-6621
KeywordsAdult, Female, Forced Expiratory Volume, Humans, Lung, Male, Middle Aged, Nutrition Surveys, Pulmonary Disease, Chronic Obstructive, Risk Factors, Spirometry, Vital Capacity
Abstract<p> Early detection of chronic obstructive pulmonary disease (COPD) is a public health priority. Airflow obstruction is the single most important risk factor for adverse COPD outcomes, but spirometry is not routinely recommended for screening. To describe the burden of subclinical airflow obstruction (SAO) and to develop a probability score for SAO to inform potential detection and prevention programs. Lung function and clinical data were harmonized and pooled across nine U.S. general population cohorts. Adults with respiratory symptoms, inhaler use, or prior diagnosis of COPD or asthma were excluded. A probability score for prevalent SAO (forced expiratory volume in 1 second/forced vital capacity < 0.70) was developed via hierarchical group-lasso regularization from clinical variables in strata of sex and smoking status, and its discriminative accuracy for SAO was assessed in the pooled cohort as well as in an external validation cohort (NHANES [National Health and Nutrition Examination Survey] 2011-2012). Incident hospitalizations and deaths due to COPD (respiratory events) were defined by adjudication or administrative criteria in four of nine cohorts. Of 33,546 participants (mean age 52 yr, 54% female, 44% non-Hispanic White), 4,424 (13.2%) had prevalent SAO. The incidence of respiratory events ( = 14,024) was threefold higher in participants with SAO versus those without (152 vs. 39 events/10,000 person-years). The probability score, which was based on six commonly available variables (age, sex, race and/or ethnicity, body mass index, smoking status, and smoking pack-years) was well calibrated and showed excellent discrimination in both the testing sample (C-statistic, 0.81; 95% confidence interval [CI], 0.80-0.82) and in NHANES (C-statistic, 0.83; 95% CI, 0.80-0.86). Among participants with predicted probabilities ⩾ 15%, 3.2 would need to undergo spirometry to detect one case of SAO. Adults with SAO demonstrate excess respiratory hospitalization and mortality. A probability score for SAO using commonly available clinical risk factors may be suitable for targeting screening and primary prevention strategies.</p>
DOI10.1513/AnnalsATS.202109-1020OC
Alternate JournalAnn Am Thorac Soc
PubMed ID35176216
PubMed Central IDPMC9353954
Grant ListR01 HL151421 / HL / NHLBI NIH HHS / United States
N01HC95160 / HL / NHLBI NIH HHS / United States
HHSN268201800012I / HB / NHLBI NIH HHS / United States
N01-HC-95164 / NH / NIH HHS / United States
R01-HL-093081 / NH / NIH HHS / United States
HHSN268201800012C / HL / NHLBI NIH HHS / United States
HHSN268201300004C / HL / NHLBI NIH HHS / United States
U01 HL041642 / HL / NHLBI NIH HHS / United States
HHSN26820180 / NH / NIH HHS / United States
HHSN268200800007C / NH / NIH HHS / United States
R21 EB027891 / EB / NIBIB NIH HHS / United States
U01 HL041654 / HL / NHLBI NIH HHS / United States
HHSN268201800004I / HL / NHLBI NIH HHS / United States
R21 HL153700 / HL / NHLBI NIH HHS / United States
N01HC95163 / HL / NHLBI NIH HHS / United States
U01 HL080295 / HL / NHLBI NIH HHS / United States
HHSN268201500001C / HL / NHLBI NIH HHS / United States
HHSN268201800004I / NH / NIH HHS / United States
HHSN268201800014I / HB / NHLBI NIH HHS / United States
U01HL080295 / NH / NIH HHS / United States
HHSN268201700002I / NH / NIH HHS / United States
U01-HL41642 / NH / NIH HHS / United States
N01-AG-6-2101 / NH / NIH HHS / United States
U01 HL130114 / HL / NHLBI NIH HHS / United States
HHSN268200800007C / HL / NHLBI NIH HHS / United States
N01HC95169 / HL / NHLBI NIH HHS / United States
N01-HC-25195 / NH / NIH HHS / United States
R01-AG028050 / NH / NIH HHS / United States
K23 HL133438 / HL / NHLBI NIH HHS / United States
R01 HL077612 / HL / NHLBI NIH HHS / United States
R21EB027891 / NH / NIH HHS / United States
N01-HC-95169 / NH / NIH HHS / United States
N01HC65236 / HL / NHLBI NIH HHS / United States
N01HC65235 / HL / NHLBI NIH HHS / United States
U01-HL41654 / NH / NIH HHS / United States
HHSN268201700001I / NH / NIH HHS / United States
U01-HL41652 / NH / NIH HHS / United States
RC1 HL100543 / HL / NHLBI NIH HHS / United States
N01HC95164 / HL / NHLBI NIH HHS / United States
N01-HC-95165 / NH / NIH HHS / United States
N01HC55222 / HL / NHLBI NIH HHS / United States
U01 HL041652 / HL / NHLBI NIH HHS / United States
HHSN26820170 / NH / NIH HHS / United States
HHSN268201800014C / HL / NHLBI NIH HHS / United States
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R01 NR012459 / NR / NINR NIH HHS / United States
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N01HC65234 / HL / NHLBI NIH HHS / United States
R01 HL093081 / HL / NHLBI NIH HHS / United States
N01HC95168 / HL / NHLBI NIH HHS / United States
R21 HL129924 / NH / NIH HHS / United States
K23 HL130627 / NH / NIH HHS / United States
HHSN268201800003I / HL / NHLBI NIH HHS / United States
N01-HC-95159 / NH / NIH HHS / United States
N01-HC-95161 / NH / NIH HHS / United States
R01-NR012459 / NH / NIH HHS / United States
R01 HL109315 / HL / NHLBI NIH HHS / United States
HHSN268201700002C / HL / NHLBI NIH HHS / United States
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HHSN268201800001C / HL / NHLBI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
N01-HC-95162 / NH / NIH HHS / United States
U01-HL65520 / NH / NIH HHS / United States
HHSN268201800013I / MD / NIMHD NIH HHS / United States
N01HC65237 / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
N01HC95165 / HL / NHLBI NIH HHS / United States
N01HC95159 / HL / NHLBI NIH HHS / United States
R21 HL129924 / HL / NHLBI NIH HHS / United States
HHSN268201500001I / NH / NIH HHS / United States
HHSN268201500001I / HL / NHLBI NIH HHS / United States
HHSN268201800014I / NH / NIH HHS / United States
R01 HL109319 / HL / NHLBI NIH HHS / United States
N01HC95161 / HL / NHLBI NIH HHS / United States
HHSN268201800013I / NH / NIH HHS / United States
HHSN268201800011C / HL / NHLBI NIH HHS / United States
R01 AG028050 / AG / NIA NIH HHS / United States
HHSN268201300003C / HG / NHGRI NIH HHS / United States
HHSN268201300001I/N01-HC-65233 / NH / NIH HHS / United States
U01HL130114 / NH / NIH HHS / United States
R01HL151421 / NH / NIH HHS / United States
R01 HL109284 / HL / NHLBI NIH HHS / United States
HHSN268201700005C / HL / NHLBI NIH HHS / United States
HHSN268201700001C / HL / NHLBI NIH HHS / United States
N01HC85082 / HL / NHLBI NIH HHS / United States
HHSN268201700003C / HL / NHLBI NIH HHS / United States
R01AG023629 / NH / NIH HHS / United States
N01HC95167 / HL / NHLBI NIH HHS / United States
N01-HC-95160 / NH / NIH HHS / United States
HHSN268201200036C / NH / NIH HHS / United States
N01HC85083 / HL / NHLBI NIH HHS / United States
R01 HL130506 / HL / NHLBI NIH HHS / United States
N01HC25195 / HL / NHLBI NIH HHS / United States
U01 HL065521 / HL / NHLBI NIH HHS / United States
HHSN268201800015I / HB / NHLBI NIH HHS / United States
HHSN268201700004C / HL / NHLBI NIH HHS / United States
N01-HC-95168 / NH / NIH HHS / United States
N01-HC-95166 / NH / NIH HHS / United States
N01-AG-6-2106 / NH / NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201800003I / NH / NIH HHS / United States
N01-HC-95163 / NH / NIH HHS / United States
HHSN268201800010I / HB / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
K23 HL133438 / NH / NIH HHS / United States
N01HC85079 / HL / NHLBI NIH HHS / United States
N01HC95166 / HL / NHLBI NIH HHS / United States
R01-HL-077612 / NH / NIH HHS / United States
K23 HL130627 / HL / NHLBI NIH HHS / United States
R01 AG023629 / AG / NIA NIH HHS / United States
HHSN268201800011I / HB / NHLBI NIH HHS / United States
RC1-HL-100543 / NH / NIH HHS / United States
HHSN268201800005I / HL / NHLBI NIH HHS / United States
R01 HL109301 / HL / NHLBI NIH HHS / United States
N01HC85080 / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States
HHSN268201800006I / HL / NHLBI NIH HHS / United States
N01-HC-95167 / NH / NIH HHS / United States
R01 HL109282 / HL / NHLBI NIH HHS / United States
N01-AG-6-2103 / NH / NIH HHS / United States
U01 HL065520 / HL / NHLBI NIH HHS / United States
N01HC85081 / HL / NHLBI NIH HHS / United States
ePub date: 
22/08

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