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Multicenter Study
. 2025 Dec 31;31(1):2430491.
doi: 10.1080/25310429.2024.2430491. Epub 2024 Dec 6.

Geographical variation in lung function: Results from the multicentric cross-sectional BOLD study

Peter G J Burney  1 , James Potts  1 , Ben Knox-Brown  1 , Gregory Erhabor  2 , Hamid Hacene Cherkaski  3 , Kevin Mortimer  4   5 , Mahesh Padukudru Anand  6 , David M Mannino  7   8 , Joao Cardoso  9   10 , Rana Ahmed  11 , Asma Elsony  11 , Cristina Barbara  12   13 , Rune Nielsen  14   15 , Eric Bateman  16 , Stefanni Nonna M Paraguas  17   18 , Li Cher Loh  19 , Abdul Rashid  19 , Emiel Fm Wouters  20   21 , Frits Me Franssen  21 , Hermínia Brites Dias  22 , Thorarinn Gislason  23   24 , Mohammed Al Ghobain  25   26 , Mohammed El Biaze  27 , Dhiraj Agarwal  28 , Sanjay Juvekar  28 , Fatima Rodrigues  13   29 , Daniel O Obaseki  2   30 , Parvaiz A Koul  31 , Imed Harrabi  32 , Asaad A Nafees  33 , Terence Seemungal  34 , Christer Janson  35 , William M Vollmer  36 , Andre Fs Amaral  1   37 , A Sonia Buist  38
Affiliations
Multicenter Study

Geographical variation in lung function: Results from the multicentric cross-sectional BOLD study

Peter G J Burney et al. Pulmonology. .

Abstract

Spirometry is used to determine what is "unusual" lung function compared with what is "usual" for healthy non-smokers. This study aimed to investigate regional variation in the forced vital capacity (FVC) and in the forced expiratory volume in one second to FVC ratio (FEV1/FVC) using cross-sectional data from all 41 sites of the multinational Burden of Obstructive Lung Disease study. Participants (5,368 men; 9,649 women), aged ≥40 years, had performed spirometry, had never smoked and reported no respiratory symptoms or diagnoses. To identify regions with similar FVC, we conducted a principal component analysis (PCA) on FVC with age, age2 and height2, separately for men and women. We regressed FVC against age, age2 and height2, and FEV1/FVC against age and height2, for each sex and site, stratified by region. Mean age was 54 years (both sexes), and mean height was 1.69 m (men) and 1.61 m (women). The PCA suggested four regions: 1) Europe and richer countries; 2) the Near East; 3) Africa; and 4) the Far East. For the FVC, there was little variation in the coefficients for age, or age2, but considerable variation in the constant (men: 2.97 L in the Far East to 4.08 L in Europe; women: 2.44 L in the Far East to 3.24 L in Europe) and the coefficient for height2. Regional differences in the constant and coefficients for FEV1/FVC were minimal (<1%). The relation of FVC with age, sex and height varies across and within regions. The same is not true for the FEV1/FVC ratio.

Keywords: Cross-sectional studies; airflow obstruction; forced expiratory volume; forced vital capacity; global health.

Plain language summary

The relation of FVC to age and height varies geographically, but there is no geographical variation in the FEV1/FVC ratio. These findings may be useful for identifying specific restrictive lung disease, and they do not alter the current advice to use a single global standard when assessing severity of disease.

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Conflict of interest statement

DM is a consultant to AstraZeneca, GlaxoSmithKline, Genentech and Up to Date, and an expert witness on behalf of people suing the Tobacco and Vaping Industries. RN has received funding from AstraZeneca and is the Chair of the Norwegian Respiratory Society. FR reports grants and personal fees from A. Menarini, Boehringer Ingelheim, Teva Pharma, Novartis, GlaxoSmithKline, AstraZeneca, VitalAire and Nippon Gases outside the submitted work.

Figures

Figure 1.
Figure 1.
Principal component analysis of FVC, age, age2 and height2 for women (a) and men (b).
Figure 2.
Figure 2.
a) Expected values (50th centile) and b) lower limit of normal (5th centile) by age, sex and region for 1.65 m person. Expected values for a 1.65 m person by age, sex and region (m: metre; FVC: forced vital capacity; LLN: lower limit of normal). b) Lower limit of normal for forced vital capacity (FVC) for a 1.65 m tall person by age, sex and region.
See this image and copyright information in PMC

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