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. 2014 Jan;69(1):55-62.
doi: 10.1136/thoraxjnl-2013-203631. Epub 2013 Aug 12.

Ethnic differences in respiratory impairment

Carlos A Vaz Fragoso  1 , Gail McAvay, Thomas M Gill, John Concato, Philip H Quanjer, Peter H Van Ness
Affiliations

Ethnic differences in respiratory impairment

Carlos A Vaz Fragoso et al. Thorax. 2014 Jan.

Abstract

Objective: Spirometric Z scores by lambda-mu-sigma (LMS) rigorously account for age-related changes in lung function. Recently, the Global Lung Function Initiative (GLI) expanded LMS spirometric Z scores to multiple ethnicities. Hence, in aging populations, the GLI provides an opportunity to rigorously evaluate ethnic differences in respiratory impairment, including airflow limitation and restrictive pattern.

Methods: Using data from the Third National Health and Nutrition Examination Survey, including participants aged 40-80, we evaluated ethnic differences in GLI-defined respiratory impairment, including prevalence and associations with mortality and respiratory symptoms.

Results: Among 3506 white Americans, 1860 African Americans and 1749 Mexican Americans, the prevalence of airflow limitation was 15.1% (13.9% to 16.4%), 12.4% (10.7% to 14.0%) and 8.2% (6.7% to 9.8%), and restrictive pattern was 5.6% (4.6% to 6.5%), 8.0% (6.9% to 9.0%) and 5.7% (4.5% to 6.9%), respectively. Airflow limitation was associated with mortality in white Americans, African Americans and Mexican Americans-adjusted HR (aHR) 1.66 (1.23 to 2.25), 1.60 (1.09 to 2.36) and 1.80 (1.17 to 2.76), respectively, but associated with respiratory symptoms only in white Americans-adjusted OR (aOR) 2.15 (1.70 to 2.73). Restrictive pattern was associated with mortality but only in white Americans and African Americans-aHR 2.56 (1.84 to 3.55) and 3.23 (2.06 to 5.05), and associated with respiratory symptoms but only in white Americans and Mexican Americans-aOR 2.16 (1.51 to 3.07) and 2.12 (1.45 to 3.08), respectively.

Conclusions: In an aging population, we found ethnic differences in GLI-defined respiratory impairment. In particular, African Americans had high rates of respiratory impairment that were associated with mortality but not respiratory symptoms.

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Conflict of interest statement

We report no conflicts of interest.

Figures

Figure 1
Figure 1
Adjusted OR (95% confidence interval) for respiratory symptoms among participants who had airflow-limitation, stratified by effect modifier — sex (Panel A) and smoking history (Panel B). Separate logistic regression models were used for each ethnic group and effect modifier combination, with normal spirometry as the reference group. Covariates included age, sex, smoking history, high CV risk, and reduced health status, without the variable that was the effect modifier of interest. Abbreviations: CI, confidence interval; CV, cardiovascular; OR, odds ratio.
Figure 1
Figure 1
Adjusted OR (95% confidence interval) for respiratory symptoms among participants who had airflow-limitation, stratified by effect modifier — sex (Panel A) and smoking history (Panel B). Separate logistic regression models were used for each ethnic group and effect modifier combination, with normal spirometry as the reference group. Covariates included age, sex, smoking history, high CV risk, and reduced health status, without the variable that was the effect modifier of interest. Abbreviations: CI, confidence interval; CV, cardiovascular; OR, odds ratio.
Figure 2
Figure 2
Adjusted OR (95% confidence interval) for respiratory symptoms among participants who had restrictive-pattern, stratified by effect modifier — sex (Panel A) and smoking history (Panel B). Separate logistic regression models were used for each ethnic group and effect modifier combination, with normal spirometry as the reference group. Covariates included age, sex, smoking history, high CV risk, and reduced health status, without the variable that was the effect modifier of interest. Abbreviations: CI, confidence interval; CV, cardiovascular; OR, odds ratio.
Figure 2
Figure 2
Adjusted OR (95% confidence interval) for respiratory symptoms among participants who had restrictive-pattern, stratified by effect modifier — sex (Panel A) and smoking history (Panel B). Separate logistic regression models were used for each ethnic group and effect modifier combination, with normal spirometry as the reference group. Covariates included age, sex, smoking history, high CV risk, and reduced health status, without the variable that was the effect modifier of interest. Abbreviations: CI, confidence interval; CV, cardiovascular; OR, odds ratio.
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