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Best lung function equations for the very elderly selected by survival analysis.

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Lung function prediction equations for nonagenarians are best derived from the US National Health and Nutrition Examination Survey (NHANES) III data, improving survival predictions in the elderly.

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Area of Science:

  • Gerontology
  • Pulmonology
  • Epidemiology

Background:

  • Accurate prediction of lung function is crucial for assessing health in elderly populations.
  • Existing lung function prediction equations may not accurately represent nonagenarians due to potential selection bias in older cohorts.

Purpose of the Study:

  • To identify which lung function prediction equations best predict survival in a cohort of nonagenarians.
  • To compare the predictive accuracy of equations derived from the US National Health and Nutrition Examination Survey (NHANES) III versus equations including elderly subjects.

Main Methods:

  • A population-based cohort of 2262 Danes born in 1905 had lung function, grip strength, and Mini Mental State Examination (MMSE) scores measured in 1998.
  • Mortality was tracked until 2011. Forced expiratory volume in 1 second (FEV1) standardized residuals (SR) were calculated using various prediction equations for 592 subjects with complete data.
  • Cox proportional hazard regression was used to analyze the association between FEV1SR and mortality, controlling for MMSE, grip strength, and sex.

Main Results:

  • Lower FEV1SR was a significant predictor of mortality in nonagenarians, even after adjusting for cognitive function, grip strength, and sex.
  • Equations from the NHANES III (1999) demonstrated a better spread of median survival across FEV1SR quartiles compared to equations derived from elderly cohorts.
  • The NHANES III equations yielded hazard ratios for death of 1, 1.16, 1.32, and 1.60 for increasing FEV1SR quartiles, indicating superior survival prediction.

Conclusions:

  • Extrapolating lung function prediction from NHANES III equations provides more accurate survival predictions in nonagenarians than using equations derived from elderly subjects.
  • The findings suggest that NHANES III equations may be more generalizable to very old populations, potentially mitigating selection bias present in elderly-specific cohorts.
  • This study provides valuable insights for the development of future lung function prediction equations tailored for the elderly, emphasizing the need for representative cohort data.