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Global Differences in Lung Function by Region (Pure): An International, Community-Based Prospective Study Publisher Pubmed



Duong M1 ; Islam S1 ; Rangarajan S1 ; Teo K1 ; Obyrne PM1 ; Schunemann HJ2 ; Igumbor E3 ; Chifamba J4 ; Liu L5 ; Li W5 ; Ismail T6 ; Shankar K7 ; Shahid M8 ; Vijayakumar K9 Show All Authors
Authors
  1. Duong M1
  2. Islam S1
  3. Rangarajan S1
  4. Teo K1
  5. Obyrne PM1
  6. Schunemann HJ2
  7. Igumbor E3
  8. Chifamba J4
  9. Liu L5
  10. Li W5
  11. Ismail T6
  12. Shankar K7
  13. Shahid M8
  14. Vijayakumar K9
  15. Yusuf R10
  16. Zatonska K11
  17. Oguz A12
  18. Rosengren A13
  19. Heidari H14
  20. Almahmeed W15
  21. Diaz R16
  22. Oliveira G17
  23. Lopezjaramillo P18
  24. Seron P19
  25. Killian K1
  26. Yusuf S2
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, Department of Medicine, Hamilton, ON, Canada
  2. 2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
  3. 3. School of Public Health, University of the Western Cape, Cape Town, South Africa
  4. 4. Physiology Department, University of Zimbabwe Medical School, Harare, Zimbabwe
  5. 5. National Centre of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, Beijing, China
  6. 6. Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
  7. 7. Epidemiology and Biostatistics, St John's Research Institute, Bangalore, India
  8. 8. Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
  9. 9. Health Action by People, Trivandrum, India
  10. 10. Independent University Bangladesh, Bashundhara, Dhaka, Bangladesh
  11. 11. Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
  12. 12. Goztepe Training and Research Hospital, Istanbul, Turkiye
  13. 13. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  14. 14. Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  15. 15. Division of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  16. 16. Estudios Clinicos Latinoamerica, Rosario, Argentina
  17. 17. Coronary Care Unit, Translational Epidemiology Division, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
  18. 18. Fundacion Oftalmologica de Santander, Floridablanca, Santander, Colombia
  19. 19. Universidad de La Frontera, Temuco, Chile

Source: The Lancet Respiratory Medicine Published:2013


Abstract

Background: Despite the rising burden of chronic respiratory diseases, global data for lung function are not available. We investigated global variation in lung function in healthy populations by region to establish whether regional factors contribute to lung function. Methods: In an international, community-based prospective study, we enrolled individuals from communities in 17 countries between Jan 1, 2005, and Dec 31, 2009 (except for in Karnataka, India, where enrolment began on Jan 1, 2003). Trained local staff obtained data from participants with interview-based questionnaires, measured weight and height, and recorded forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). We analysed data from participants 130-190 cm tall and aged 34-80 years who had a 5 pack-year smoking history or less, who were not affected by specified disorders and were not pregnant, and for whom we had at least two FEV1 and FVC measurements that did not vary by more than 200 mL. We divided the countries into seven socioeconomic and geographical regions: south Asia (India, Bangladesh, and Pakistan), east Asia (China), southeast Asia (Malaysia), sub-Saharan Africa (South Africa and Zimbabwe), South America (Argentina, Brazil, Colombia, and Chile), the Middle East (Iran, United Arab Emirates, and Turkey), and North America or Europe (Canada, Sweden, and Poland). Data were analysed with non-linear regression to model height, age, sex, and region. Findings: 153 996 individuals were enrolled from 628 communities. Data from 38 517 asymptomatic, healthy non-smokers (25 614 women; 12 903 men) were analysed. For all regions, lung function increased with height non-linearly, decreased with age, and was proportionately higher in men than women. The quantitative effect of height, age, and sex on lung function differed by region. Compared with North America or Europe, FEV1 adjusted for height, age, and sex was 31·3% (95% CI 30·8-31·8%) lower in south Asia, 24·2% (23·5-24·9%) lower in southeast Asia, 12·8% (12·4-13·4%) lower in east Asia, 20·9% (19·9-22·0%) lower in sub-Saharan Africa, 5·7% (5·1-6·4%) lower in South America, and 11·2% (10·6-11·8%) lower in the Middle East. We recorded similar but larger differences in FVC. The differences were not accounted for by variation in weight, urban versus rural location, and education level between regions. Interpretation: Lung function differs substantially between regions of the world. These large differences are not explained by factors investigated in this study; the contribution of socioeconomic, genetic, and environmental factors and their interactions with lung function and lung health need further clarification. Funding: Full funding sources listed at end of the paper (see Acknowledgments). © 2013 Elsevier Ltd.
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