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. 2016 Jul;71(7):624-32.
doi: 10.1136/thoraxjnl-2015-207822. Epub 2016 Apr 5.

Per cent emphysema is associated with respiratory and lung cancer mortality in the general population: a cohort study

Elizabeth C Oelsner  1 , J Jeffrey Carr  2 , Paul L Enright  3 , Eric A Hoffman  4 , Aaron R Folsom  5 , Steven M Kawut  6 , Richard A Kronmal  7 , David J Lederer  8 , Joao A C Lima  9 , Gina S Lovasi  10 , Benjamin M Smith  11 , Steven J Shea  1 , R Graham Barr  1
Affiliations

Per cent emphysema is associated with respiratory and lung cancer mortality in the general population: a cohort study

Elizabeth C Oelsner et al. Thorax. 2016 Jul.

Abstract

Background: Emphysema on CT is a risk factor for all-cause mortality in persons with and without airflow obstruction; however, causes of death associated with emphysema remain uncertain, particularly in the general population.

Aims: To test associations between quantitatively assessed emphysema on CT and cause of death in persons with and without a substantial smoking history.

Methods: The Multi-Ethnic Study of Atherosclerosis recruited 6814 participants, aged 45-84 years and without clinical cardiovascular disease, in 2000-2002. Per cent emphysema was defined on cardiac CT as per cent of lung voxels less than -950 Hounsfield units; emphysema on CT was defined as per cent emphysema above the upper limit of normal. Cause of death was classified by administrative codes. Proportional-hazards models were adjusted for age, race/ethnicity, gender, body mass index, smoking status, pack-years, coronary artery calcium, site and education. Additional adjustment for lung function was made in a subset with spirometry from 2004 to 2006.

Results: There were 1091 deaths over 12 years median follow-up. Emphysema on CT was strongly associated with increased mortality due to respiratory diseases (adjusted HR 2.94, 95% CI 1.68 to 5.15), particularly chronic lower respiratory diseases (adjusted HR 9.54, 95% CI 4.70 to 19.35), and lung cancer (adjusted HR 1.84, 95% CI 1.09 to 3.12), but not cardiovascular disease. Associations persisted among participants with fewer than 10 pack-years and those without physician-diagnosed respiratory disease, and were similar after adjustment for airflow measures and in persons without airflow limitation.

Conclusions: Quantitatively assessed emphysema on CT is associated with greater respiratory disease and lung cancer mortality, even among persons without traditional risk factors.

Keywords: COPD epidemiology; Emphysema; Imaging/CT MRI etc; Lung Cancer.

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Conflict of interest statement

Competing Interests: The authors have no relevant disclosures with the following exceptions. Eric A. Hoffman is a founder and shareholder of VIDA Diagnostics, a company commercializing lung imaging analysis software developed, in part, at the University of Iowa. He is also a non-paid member of Siemens Medical Imaging CT advisory board. Dr. Lederer reports serving as a consultant to Gilead, Intermune, Boehinger-Ingelheim, Immuneworks, and XVIVO therapeutics related to clinical trials in IPF and lung transplantation. Dr. Kawut reports personal fees from Insmed, non-financial support from ACCP, non-financial support from ATS, personal fees from European Respiratory Journal, grants from Actelion, grants from United Therapeutics, grants from Gilead, grants from Lung Biotech, grants from Pfizer, grants from Ikaria, grants from Pulmonary Hypertension Association, grants from Actelion, grants from Gilead, grants from Merck, grants from GeNO, grants from Bayer, all outside the submitted work. Dr. Lima reports grants from Toshiba Medical Systems, outside the submitted work. Dr. Barr reports personal fees from UpToDate, non-financial support from COPD Foundation, both outside the submitted work.

Figures

Figure 1
Figure 1
Top three leading causes of death in the Multi-Ethnic Study of Atherosclerosis (MESA), 2000–2013.
Figure 2
Figure 2
Cumulative incidence of mortality due to lung diseases according to presence or absence of emphysema on computed tomography (CT) over 12 years of follow-up in the Multi-Ethnic Study of Atherosclerosis (MESA), 2000–2013.
Figure 3
Figure 3
Emphysema on computed tomography and mortality due to lung diseases, stratified by smoking history.
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