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. 2023 Jun;78(6):559-565.
doi: 10.1136/thoraxjnl-2021-218315. Epub 2022 Jul 1.

The relationship between interstitial lung abnormalities, mortality, and multimorbidity: a cohort study

Jason Leigh Sanders #  1 , Gisli Axelsson #  2   3 , Rachel Putman  4 , Aravind Menon  4 , Josée Dupuis  5 , Hanfei Xu  5 , Shuai Wang  6 , Joanne Murabito  7   8 , Ramachandran Vasan  7   8 , Tetsuro Araki  9 , Mizuki Nishino  10 , George R Washko  4 , Hiroto Hatabu  10   11 , George O'Connor  8   12 , Gunnar Gudmundsson  2   13 , Vilmundur Gudnason  2   3 , Gary M Hunninghake  14
Affiliations

The relationship between interstitial lung abnormalities, mortality, and multimorbidity: a cohort study

Jason Leigh Sanders et al. Thorax. 2023 Jun.

Abstract

Background: Interstitial lung abnormalities (ILAs) are associated with increased mortality. It is unclear whether multimorbidity accounts for the mortality association or how strongly ILA is associated with mortality relative to other common age-associated diseases. We determined the association of ILA with all-cause mortality adjusted for multimorbidity, compared mortality associated with ILA and prevalent cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease and cancer and also determined the association between ILA and these diseases.

Methods: We measured ILA (none, indeterminant, definite) using blinded reads of CT images, prevalent chronic diseases and potential confounders in two observational cohorts, the Framingham Heart Study (FHS) (n=2449) and Age, Gene/Environment Susceptibility - Reykjavik Study (AGES-Reykjavik) (n=5180). We determined associations with mortality using Cox proportional hazards models and between ILA and diseases with multinomial logistic regression.

Results: Over a median (IQR) follow-up of 8.8 (1.4) years in FHS and 12.0 (7.7) years in AGES-Reykjavik, in adjusted models, ILAs were significantly associated with increased mortality (HR, 95% CI 1.95, 1.23 to 3.08, p=0.0042, in FHS; HR 1.60, 1.41 to 1.82, p<0.0001, in AGES-Reykjavik) adjusted for multimorbidity. In both cohorts, the association of ILA with mortality was of similar magnitude to the association of most other diseases. In adjusted models, ILAs were associated only with prevalent kidney disease (OR, 95% CI 1.90, 1.01 to 3.57, p=0.0452) in FHS and with prevalent CVD (OR 1.42, 1.12 to 1.81, p=0.0040) in AGES-Reykjavik.

Conclusions: ILAs were associated with mortality adjusted for multimorbidity and were similarly associated with increased mortality compared with several common chronic diseases. ILAs were not consistently associated with the prevalence of these diseases themselves.

Keywords: clinical epidemiology; idiopathic pulmonary fibrosis; imaging/CT MRI etc.

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Conflict of interest statement

Competing interests: JLS reports personal fees for consultancy from Apneo Therapeutics and Decimal.health, outside the submitted work. At the time of publication, JLS was employed by Vertex Pharmaceuticals. MN reports personal fees for consultancy from Daiichi Sankyo and AstraZeneca; honoraria from Roche; and grants from Merck, AstraZeneca, Canon Medical Systems and NIH (R01CA203636, U01CA209414, R01HL111024), outside the submitted work. HH reports grants from Canon Medical System Inc. and Konica-Minolta Inc., personal fees for consultancy from Mitsubishi Chemical Inc. and personal fees for advisory board work from Canon Medical System Inc., outside the submitted work. JM reports fees to her institution on her behalf for guest lecture/consultant outside the submitted work from Merck. GMH reports personal fees from Genentech, Boehringer Ingelheim, The Gerson Lehrman Group and Mitsubishi Chemical, outside the submitted work.

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