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Pulmonary Function Trajectories Preceding Death Among Older Adults: A Long-Term Community-Based Cohort Study
Jiao Wang1,2, Jie Guo3, Abigail Dove3
1Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Summary
Poor pulmonary function (PF) is linked to increased mortality in older adults, shortening survival by nearly two years. Declines in PF accelerate approximately seven years before death, suggesting PF as a potential mortality predictor.
Area of Science:
- Gerontology
- Pulmonology
- Epidemiology
Background:
- Pulmonary function (PF) is a known predictor of mortality, but the precise timing of PF decline before death is not well understood.
- Investigating the relationship between PF and mortality is crucial for understanding aging and disease progression.
Purpose of the Study:
- To examine the association between pulmonary function and mortality in older adults.
- To identify specific trajectories of pulmonary function decline preceding death.
Main Methods:
- The study followed 1,438 participants (without COPD) for up to 22 years, assessing annual PF using a composite score (forced vital capacity, forced expiratory volume in 1s, peak expiratory flow).
- Survival status was monitored, and data were analyzed using Cox regression, Laplace regression, and mixed-effect models.
Main Results:
- Over 51% of participants died during follow-up. Lower PF was associated with significantly higher mortality risk and reduced median survival time.
- Significant differences in composite PF, FEV1, FVC, and PEF between decedents and survivors emerged 6-8 years before death, with declines accelerating thereafter.
Conclusions:
- Poor pulmonary function is associated with elevated mortality and approximately a two-year reduction in survival.
- An accelerated decline in pulmonary function typically begins seven years prior to death.
- Pulmonary function and its decline may serve as valuable predictors of mortality in community-dwelling older adults.
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