Chest Radiograph-Derived Age Acceleration as an Early Marker of Pulmonary Dysfunction in Middle-Aged Asian Adults

Deep learning-derived chest radiographic age may capture subclinical structural changes associated with spirometric impairment.

Is chest radiograph (CXR)-based accelerated aging associated with the prevalence and incidence of preserved ratio impaired spirometry (PRISm) and obstructive lung disease (OLD)?

This retrospective study included Korean adults who underwent CXRs and spirometry during regular health checkups between 2006 and 2019. Participants were categorized into decelerated (< -2.0 years), reference (-2.0 to 1.9 years), or accelerated (≥ 2.0 years) aging groups according to CXR-Lung-Risk scores relative to chronological age derived from baseline CXRs. Prevalent PRISm (FEV₁ < 80% predicted with FEV₁/FVC ≥ 0.70) and OLD (FEV₁/FVC < 0.70) were defined based on baseline spirometry and assessed using multivariable multinomial logistic regression. Incident PRISm and OLD were evaluated among participants with normal baseline spirometry using follow-up spirometry data through December 31, 2022, and associations were estimated using multivariable Cox proportional hazards models.

Among 231,278 participants (mean age, 50.7 ± 8.8 years; 55.0% male), the prevalence of PRISm and OLD was 2.2% (5,161 of 231,278) and 4.6% (10,557 of 231,278), respectively. Compared with those in the reference group, participants with accelerated aging had higher odds of prevalent PRISm (adjusted OR; 1.37; 95% CI, 1.28-1.46) and OLD (adjusted OR, 1.58; 95% CI, 1.51-1.65). In the longitudinal analysis including 104,158 participants (median follow-up, 4.3 years), accelerated aging was associated with higher risks of incident PRISm (adjusted hazard ratio, 1.37; 95% CI, 1.27-1.48) and OLD (adjusted hazard ratio, 1.28; 95% CI, 1.20-1.37). Associations were directionally consistent across subgroups defined by age, sex, smoking status, and BMI, with most subgroup analyses remaining statistically significant.

Our results show that CXR-derived accelerated aging was associated with both current and future PRISm and OLD. These findings support a potential complementary role for routine CXRs in opportunistic identification of pulmonary dysfunction.