Respiratory Disease Mortality Research Articles

Long-term exposure to PM2.5 and mortality among Japanese community-dwelling adults

Abstract Background Long-term exposure to PM2.5 (particulate matter with a diameter of 2.5 μm or smaller) is a risk factor for mortality and cardiovascular disease including stroke. However, there was limited evidence for the association between PM2.5 exposure and stroke in Asia where the major cardiovascular disease is stroke. Additionally, the causal association between PM2.5 and respiratory disease is still unresolved. The aim of this study was to investigate the association between long-term exposure to PM2.5 and all-cause, cardiovascular, and respiratory disease mortality in a Japanese community-based prospective cohort. Methods This study included 46,974 participants (19,707 men; 27,267 women) from the second cohort of the Ibaraki Prefectural Health Study. The participants were followed up from baseline survey (in 2009) to 31 December 2019. We confirmed underlying causes by death certificates. Using the PM2.5 concentrations estimated by the inverse distance weighting methods based on ambient air monitoring data, administrative area level concentrations were assigned to each participant. The hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality using a Cox proportional hazard model were presented. Results We identified 2,789 all-cause deaths during the 470,178 person-years of follow-up. PM2.5 exposure had no significant association with all-cause and cause-specific mortality. The multivariable-adjusted HRs per 1 μg/m3 increase in the PM2.5 concentration were 0.94 (95% CI = 0.80-1.12) for coronary heart disease, 0.92 (95% CI = 0.81-1.04) for stroke and 1.09 (95% CI = 0.97-1.23) for non-malignant respiratory disease. Conclusions We observed little evidence of increased risk of all-cause and cause-specific mortality by long-term exposure to PM2.5 whose concentrations ranged from 8.3 to 13.1 μg/m3. A somewhat increased trend for non-malignant respiratory disease mortality may not be negligible. Key messages • We found little evidence of increased risk of all-cause and cause-specific mortality by long-term exposure to PM2.5. • Somewhat increased tendency for non-malignant respiratory disease mortality associated with PM2.5 exposure was observed.

African dust: Occurrence, health consequences, and impacts on Texas

The drylands of North Africa (Sahara and Sahel) are the world’s largest sources of airborne dust. Clouds of African dust aerosols have been long known to be blown westwards across the Atlantic, and by the 1990s were recognized to be transported across and over Texas. African dust incursions in Texas typically happen several times per year in late spring and summer, manifesting as hazy skies overhead and increased ground-level concentrations of PM2.5 (particulate matter fine enough to be inhaled into the human lower respiratory tract). African dust exposure has many reported human health effects in Europe and the Caribbean, including increased all-cause mortality and increased respiratory and cardiovascular disease morbidity and mortality. In Texas, African dust’s greatest impacts occur in the Houston metropolitan area where it has been quantitatively shown to increase ambient aerosol concentrations. The potential of African dust increasing concentrations of inhalable particulate matter beyond regulatory limits is of concern. A sequence of investigations filtering particles from the air, measuring their concentrations, and subjecting them to elemental analysis documented far-transported African dust’s role in air quality in Houston and Galveston. African dust’s contributions to air pollution have been separated from those of local soils and industrial emissions, and Saharan-Sahelian dust has been indicated to sometimes constitute the majority of PM2.5 mass in Houston. While studies show the presence of inhalable metals and microorganisms including opportunistic pathogens during Saharan air incursions in Houston, the human health effects of African dust in Texas remain yet unspecified and merit further investigation. Keywords: aerosols; Africa, Northern; air pollution; dust; particulate matter; public health; Texas

Assessing the impact of meteorological factors and air pollution on respiratory disease mortality rates: a random forest model analysis (2017-2021).

Air pollution poses a significant threat to the health of all living beings on our planet. It has been scientifically established as a crucial factor affecting mortality rates, respiratory illnesses, mental well-being, and overall health. This study aimed to investigate the impact of air pollution and meteorological factors on respiratory disease mortality rates in Mashhad in 2017-2021 using a Random Forest (RF) model. At first, the daily statistics of meteorological parameters (pressure, humidity, temperature, solar radiation) during 2017-2021 were collected. The information related to pollutants pollutants such as PM2.5 (which is defined as particulate matter with less than 2.5 micrometer diameter and potentially harmful to humans), PM10 (Particles with a diameter of 10 micrometers or less that can negatively impact both human health and environmental conditions.), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) was collected. the mortality statistics from respiratory diseases were collected from the Health system registaration (Sina). Then we used the RF regression model in Excel and Python software to investigate the interaction between the mentioned variables. The escalating trend of air pollution in Mashhad has led to an expected increase in respiratory-related hospitalizations. This necessitates urgent air pollution control measures. Concurrently, the study of pollutants and climatic elements, as substantiated by global epidemiological studies, is crucial. In Mashhad, the second most polluted city in Iran, climatic factors like humidity, sunshine duration, temperature, pressure, and sunlight intensity exacerbate atmospheric pollution levels, impacting human health and ecosystems. The R2, RSME, and MAE of RF model are 0.73, 2.52, and 2 which indicate that the model has successfully identified the relationship between input variables and the target variable, and it will exhibit high accuracy in predictions. In this study, the most influential factor was identified when the Variance Inflation (VI) factor reached a value of 0.548. This indicates a strong correlation between this factor and the death rate of patients during the specified period. Furthermore, we analyzed by excluding the day and month plans from our model. The results showed that the factor with the highest coefficient in the executive model was related to pressure, with a VI value of 0.049. This suggests that pressure plays a significant role in our model and has a substantial effect on the death rate of patients. In the study of various pollutants, it was found that PM10 had the most significant impact on the mortality rate of patients with respiratory conditions, with a VI of 0.039. Following PM10, the pollutants with the next highest coefficients of importance were NO2 (VI = 0.034), SO2 (VI = 0.033), PM2.5 (VI = 0.029), and CO (VI = 0.025), respectively. Furthermore, the study observed a notable increase in the mortality rate of respiratory patients over time. Specifically, for every five days, the death rate increased by 35.5%. Indeed, climate change and air pollution significantly contribute to the mortality rate from respiratory diseases. Therefore, it is crucial for individuals, particularly those with respiratory conditions, to heed meteorological warnings.

Health effects of greenspace morphology: Large, irregular-shaped, well-connected, and close-clustered greenspaces may reduce mortality risks, especially for neighborhoods with higher aging levels

The healthcare burden has intensified with urbanization and aging populations in many global cities. While the health effects of urban greenspaces have been well documented, little is known about the associations between greenspace morphological features and health, especially in a high-density city with significant aging populations. Drawing on land use data with 10-m resolution, we assessed seven greenspace morphological metrics in terms of size (the percentage of greenspace, the largest pixel index, the average greenspace area), fragmentation (the patch density), shape (the average weighted shape index), connectedness (the cohesion index), and proximity (the aggregation index). We further conducted an ecological study to examine their associations with all-cause and three cause-specific (cardiovascular disease, respiratory disease, and cancer) mortality. Results from the negative binomial regression models revealed protective effects of five greenspace morphology metrics, including the percentage of greenspace, the largest pixel index, the average weighted shape index, the cohesion index, and the aggregation index, on mortality. The shape index showed the greatest effects, with every 1 Standard Deviation (SD) increase in the shape index linked to a reduction of 22.1% (95% CI: 22.0%–31.0%) in all-cause mortality, 22.1% (12.2%–30.8%) in mortality from cardiovascular diseases, 25.0% (14.0%–34.6%) in mortality from respiratory diseases, and 22.0% (12.3%–30.6%) in mortality from cancers. Moreover, stratified analyses revealed that the health effects of the cohesion index and the aggregation index were significantly more pronounced in neighborhoods with higher aging levels. Our findings highlight the significance of greenspace morphology features, beyond greenspace quantity, in improving residents’ health, particularly for societies with high aging populations.

The impact of green space on nonaccidental and cause-specific mortality in the Adventist Health Study-2 population.

There is growing interest in evaluating the long-term health effects of neighborhood environments, particularly green space. However, only a limited body of research further incorporates multiple ambient air pollutants. This study looked at the relationship between green space, as measured by the Normalized Difference Vegetation Index, and mortality adjusted by key confounders in the Adventist Health Study-2, a longitudinal cohort study from 2002 to 2015, across the contiguous United States (N = 67,400). We used Cox proportional hazard regression models to assess the risk of nonaccidental, cardiovascular disease (CVD), ischemic heart disease (IHD), and respiratory disease mortality from green space around subjects' home address under multiple covariate and pollutant adjustments. We found a 0.1 unit increase in the Normalized Difference Vegetation Index was associated with nonaccidental (hazard ratio [HR]: 0.96 [95% confidence interval (CI): 0.93, 0.99]), CVD (HR: 0.94 [95% CI: 0.90, 0.98]), and IHD (HR: 0.87 [95% CI: 0.81, 0.94]) mortality, with the greatest precision in fully adjusted three-pollutant models using the 1000-m buffer. Effect estimates were strengthened in urban areas, when incorporating seasons, and for females. However, all associations between green space and respiratory mortality were null. This study supports evidence that increased neighborhood green space is inversely associated with nonaccidental, CVD, and IHD mortality, where the inclusion of multiple environmental covariates had a greater impact on effect estimate magnitude and precision than adjustment by individual lifestyle and health factors.

Area-level socioeconomic inequalities in mortality in China: a nationwide cohort study based on the ChinaHEART project

Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality. In this nationwide cohort study, residents aged 35-75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper-Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators. Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18-5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07-1·16), cardiovascular disease (1·38, 1·29-1·48), and respiratory disease (1·44, 1·22-1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution. There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity. The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China. For the Chinese translation of the abstract see Supplementary Materials section.

Bovine Respiratory Disease (BRD) in Post-Weaning Calves with Different Prevention Strategies and the Impact on Performance and Health Status

Our study aimed to compare Bovine Respiratory Disease (BRD) morbidity, mortality, and growth in dairy and dairy beef cross-bred calves during the commingle period, 81–120 days of age, using two different BRD prevention strategies. The calves (n = 1799) were randomly assigned into groups: (1) Control (CON; received no vaccine or metaphylaxis); (2) Tulathromycin metaphylaxis (TUL; IncrexxaTM, Elanco Animal Health Inc., Greenfield, IN, USA); and (3) Mannheimia haemolytica vaccine (VACC; Nuplura® PH, Elanco Animal Health Inc., Greenfield, IN, USA). Calves were individually weighed three times during the study to estimate average daily gain (ADG). Deep nasopharyngeal swabs, thoracic ultrasonography, health scores, and treatment records were collected during the study. Ultrasound and health score results were not different across treatments. In this study, the TUL group had a lower cumulative BRD incidence than CON. The cumulative incidence and 95% CI of BRD during the commingle period, 81–120 days of age for CON, TUL, and VACC were 0.43 (0.38 to 0.47), 0.36 (0.38 to 0.40), and 0.39 (0.35 to 0.43), respectively. The ADG for CON, TUL, and VACC were 0.25 ± 0.15, 0.32 ± 0.15, and 0.17 ± 0.15 kg, respectively. There was no difference among the treatment groups for ADG. Management and environmental conditions were variable at this operation throughout the study period and likely impacted the calves. Earlier interventions may be needed when the BRD incidence is elevated in high-risk calves.

Association of hemoglobin, albumin, lymphocyte, and platelet score with risk of all-cause and cause-specific mortality among cancer survivors: NHANES 1999-2018.

The HALP score, comprising hemoglobin, albumin, lymphocyte, and platelet levels, serves as an indicator of both nutritional and inflammatory status. However, its correlation with all-cause and cause-specific mortality among cancer survivors remains unclear. Therefore, this study aims to investigate the relationship between HALP scores and mortality outcomes in this population. We extracted cohort data spanning ten cycles (1999-2018) from the U.S. National Health and Nutrition Examination Survey (NHANES). Mortality rates, determined using the National Death Index (NDI) as of December 31, 2019, were assessed. Weighted multivariate logistic regression analyzed the association between HALP scores and cancer prevalence. Kaplan-Meier analyses and weighted multivariate-adjusted Cox analyses investigated the link between HALP scores and all-cause and cause-specific mortality in cancer survivors. Restricted cubic spline (RCS) analysis was employed to assess nonlinear relationships. Furthermore, multi-parametric subgroup analyses were conducted to ensure the robustness of the results. Our study included 41,231 participants, of whom 3,786 were cancer survivors (prevalence: 9.5%). Over a median follow-up of 91 months (range: 51-136), we observed 1,339 deaths, including 397 from cancer, 368 from cardio-cerebrovascular disease, and 105 from respiratory disease. Elevated HALP scores showed a consistent association with reduced cancer incidence (P for trend <0.001). In multivariable-adjusted Cox regression analyses, HALP scores were significantly inversely associated with all-cause mortality, cancer mortality, cardio-cerebrovascular disease mortality, and respiratory disease mortality in cancer survivors (P for trend < 0.05). Nonlinear relationships between HALP scores and all-cause and cause-specific mortality in cancer survivors were evident through RCS regression modeling (P for nonlinearity < 0.01). Kaplan-Meier analyses demonstrated that higher HALP scores were indicative of a poorer prognosis. Our findings indicate a notable inverse correlation between HALP scores and both all-cause and cause-specific mortality among cancer survivors.

From Atmosphere to Health Outcomes: Analyzing Predictors of Respiratory Disease Mortality in Turkiye

ABSTRACTBackgroundAsthma, chronic obstructive pulmonary disease (COPD), and pneumonia are significant contributors to morbidity and mortality worldwide. Identifying the predictors of mortality due to these diseases is crucial for effective public health interventions.MethodsWe conducted a longitudinal trajectory modeling using SAS TRAJ procedures on data from 81 provinces in Turkiye, categorizing death rates into two profiles for asthma and COPD and three for pneumonia. Environmental and socioeconomic factors were examined as potential predictors through logistic regression modeling.ResultsFor asthma, none of the predictors met the false discovery rate (FDR) threshold for significance, suggesting the need for further research. In contrast, COPD predictors showed robust associations with mortality rates, particularly concerning environmental factors such as humidity and temperature. Pneumonia mortality was significantly associated with factors, including air pressure, humidity, temperature, alcohol use, and particulate matter.ConclusionThe study reveals distinct mortality profiles for respiratory diseases and highlights the importance of environmental and lifestyle factors as predictors. These findings emphasize the need for targeted public health strategies and interventions to manage these diseases effectively.

Mortality after partner's cancer diagnosis or death: A population-based prospective cohort study in Japan.

The health statuses of closely connected individuals are interdependent. Little is known about mortality risk associated with partner's cancer diagnosis and cause-specific mortality risk associated with partner's death. Relative risks for all-cause and cause-specific mortality following a partner's cancer diagnosis or death compared to the period when the partner is cancer-free and alive were investigated in the population-based prospective cohort study that enrolled 140,420 people at the age between 40-69 in 1990-1994. 55,050 participants (27,665 men and 27,385 women) who were identified as married couples were followed-up for 1,073,746.1 (518,368.5 in men and 555,377.6 in women) person-years, during which 9,816 deaths (7,217 in men and 2,599 in women) were observed. After a partner's cancer diagnosis, the mortality rate ratio (MRR) of all-cause mortality was not increased among both men and women, while an increase of externally-caused MRR was observed. The suicide MRR significantly increased among men (MRR = 2.90 [95% CI, 1.70-4.93]) and it persisted for more than 5 years. After a partner's death, the MRRs of all-cause, cardiovascular disease (CVD), respiratory disease (RD), and externally-caused mortality significantly increased only among men. Stratified analysis by smoking status among men showed significantly increased MRRs of CVD and RD mortality among former/current smokers, but not among never-smokers. Partner's cancer diagnosis did not increase all-cause mortality risk, but increased externally-caused mortality risk, especially suicide among men. The impact of partner's death on mortality risk differed by the mortality causes and sex, and smoking affected some of cause-specific mortality risk.

Assessment of the Respiratory Disease Mortality Risk from Single and Composite Exposures to PM2.5 and Ozone - Guangzhou City, Guangdong Province, China, 2018-2021.

Fine particulate matter (PM2.5) and ozone (O3) are prevalent pollutants in the atmosphere, which threaten human health, especially the respiratory system. Typically, people are exposed to a mixture of various pollutants in the environment. Thus, the single and combined effects of both pollutants need to be investigated. PM2.5 and O3 increase the risk of death from lung cancer, chronic obstructive pulmonary disease (COPD), and respiratory diseases, with their lagged and cumulative effects analyzed, indicating an acute effect. In addition, combined exposure to both pollutants can significantly affect disease deaths. This study provides further evidence of the single and combined effects of PM2.5 and O3 on respiratory diseases, emphasizing the need for sustained efforts in air pollution control, with greater attention to the synergistic management of air pollutants.

Elevated inflammatory burden index increases mortality in adults with chronic inflammatory airway diseases: a nationwide cohort study

ObjectiveThe objective of this study was to investigate the potential association between the inflammatory burden index (IBI) and the prevalence of chronic inflammatory airway diseases (CIAD), as well as mortality rates among individuals diagnosed with CIAD.MethodsParticipants were sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2010. The IBI was calculated using the formula: IBI = C-reactive protein * neutrophils / lymphocytes. CIAD comprised self-reported asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Mortality outcomes, including all-cause and respiratory disease mortality, were determined through linked data from the National Death Index (NDI) up to December 2019.ResultsA total of 27,495 adults were included. IBI was divided into quartiles, with the lowest quartile as the reference group. After adjusting for confounding variables, a positive correlation was observed between higher IBI and increased prevalence of total CIAD (OR = 1.383 [1.215–1.575]), asthma (OR = 1.267 [1.096–1.465]), chronic bronchitis (OR = 1.568 [1.263–1.946]), and COPD (OR = 1.907 [1.311–2.774]). Over a median follow-up of 12.33 [9.92-16.00] years, there were 1221 deaths from all causes and 220 deaths from respiratory disease among 4499 patients with CIAD. Following multivariate adjustments, the fourth quartile was significantly associated with increased risk of all-cause mortality (HR = 2.227 [1.714–2.893]) and respiratory disease mortality (HR = 2.748 [1.383–5.459]) compared to the first quartile of IBI in CIAD participants. Moreover, variable importance analysis using a random survival forest model demonstrated the significance of IBI in predicting mortality from both all-cause and respiratory diseases.ConclusionIBI exhibited an association with the prevalence of CIAD, with higher IBI levels correlating with elevated all-cause and respiratory disease mortality among individuals with CIAD.

Spatial association between chronic respiratory disease mortality rates and industrial manufacturing enterprises: A case study of Chongqing, China

Industry has long been a driving force in the national economy of Chongqing, a traditional industrial hub in China. Current research provides limited understanding of the spatial associations between industrial manufacturing enterprises and CRD mortality in urban areas of Western China. This study employs location data of CRD death patients and Points of Interest (POI) representing industrial manufacturing enterprises from 2012 to 2020. It explores their spatial patterns and associations through spatial clustering identification, co-location, and association effects. Key spatial association characteristics identified include: (1) High-risk CRD mortality areas are predominantly located in Tongnan District and Kaizhou District in the western and northeastern parts of Chongqing, with an increase in CRD mortality rates correlated with age and a higher prevalence among females. (2) The optimal bandwidths for spatial association characteristics are 0.18 m and 0.475 m, respectively. (3) The construction and mining industries exert a more substantial impact on the mortality rates of younger CRD patients, with a notably stronger spatial impact on male patients compared to female patients. These insights are critical for guiding public health policy and spatial planning of industrial manufacturing enterprises in Chongqing.

Risk Factors, Morbidity, and Mortality in Association With Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern: Clinical Relevance of Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern

BackgroundPreserved Ratio Impaired Spirometry (PRISm) and Restrictive Spirometric Pattern (RSP) are often considered interchangeable in identifying restrictive impairment in spirometry. Research QuestionDo PRISm and RSP have different individual associations with risk factors, morbidity, and mortality? Study Design and MethodsIn a cross-sectional and longitudinal study, including 26,091 30–46-year-old Norwegian general population men, we explored the association of PRISm and RSP with smoking habits, BMI, education, respiratory symptoms, self-reported cardiopulmonary disease, and mortality after 26 years of follow-up. PRISm was defined as FEV1/FVC ≥ lower limit of normal (LLN) & FEV1<LLN, RSP as FEV1/FVC≥LLN & FVC<LLN. We compared the associations of PRISm and RSP to airflow obstruction and normal spirometry, both as mutually (PRISm-alone, RSP-alone) and non-mutually exclusive (PRISm, RSP) categories, adjusting for age, BMI, smoking, education. We also conducted sensitivity analyses using GOLD criteria to define spirometric abnormalities. ResultsThe prevalence of the mutually exclusive spirometric patterns was: normal 82.4%, obstruction 11.0%, PRISm-alone 1.4%, RSP-alone 1.7%, PRISm+RSP 3.5%. PRISm-alone subjects were frequently obese (11.2%), current or former smokers, commonly reporting cough, phlegm, wheeze, asthma, and bronchitis. RSP-alone subjects were both obese (14.6%) and underweight (2.9%), with increased breathlessness, but similar smoking habits to subjects with normal spirometry. The prevalence of heart disease was 4.6% in PRISm-alone, 2.7% in RSP-alone and 1.6% in obstruction. With normal spirometry as a reference, RSP-alone had increased all-cause (HR 1.57 (1.21–2.04 95%CI), cardiovascular (1.48 (0.88–2.48)), diabetes (6.43 (1.88–21.97)), and cancer (excl. lung) mortality (1.51 (0.95–2.42)). PRISm-alone had increased respiratory disease mortality (HR 4.00 (1.22–13.16 95%CI)). Subjects with PRISm+RSP had intermediate characteristics and the worst prognosis. Findings were overall confirmed with non-mutually exclusive categories and GOLD criteria. InterpretationPRISm and RSP are spirometric patterns with distinct risk factors, morbidity and mortality, which should be differentiated in future studies.

Association of naples prognostic score and lung health: A population-based study

BackgroundThe Naples Prognostic Score (NPS) is a novel indicator of inflammatory and nutritional status, but its relationship to lung health is unknown. ObjectiveTo evaluate the relationship of NPS to lung health problems. MethodsA total of 15,600 participants aged 20 years or older with an available assessment of chronic lung diseases were enrolled from the National Health and Nutrition Examination Survey 2007–2012. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Associations of NPS with chronic lung disease (diagnosed asthma, chronic bronchitis, and emphysema), respiratory symptoms (cough, phlegm production, wheeze, and exertional dyspnea), and spirometric measurements (FEV1, FVC, and obstructive or restrictive spirometry pattern) were evaluated. Kaplan-Meier survival analysis and multiple Cox regressions were used to assess the significance of NPS in relation to all-cause mortality and chronic lower respiratory diseases mortality in participants. Furthermore, to comprehensively assess the association between NSP and chronic lower respiratory diseases mortality, Fine-Gray subdistribution hazards model was performed to analyze non-chronic lower respiratory diseases mortality as a competitive risk. ResultsPeople with a higher NPS score were associated with greater odds of asthma, chronic bronchitis, respiratory symptoms (including phlegm production, wheeze, and exertional dyspnea), and a greater risk of obstructive and restrictive spirometry. A higher NPS score was significantly associated with decreased FEV1 and FVC in both overall participants and those with lung health problems. Longitudinally, we found that those in the category with highest NPS were at greater risk of all-cause mortality and chronic lower respiratory diseases mortality in those with chronic lung disease, and respiratory symptoms. ConclusionsAn elevated NPS is associated with a host of adverse pulmonary outcomes. Prospective studies to define NPS as a biomarker for impaired lung health are warranted.

External Testing of a Deep Learning Model to Estimate Biologic Age Using Chest Radiographs.

Purpose To assess the prognostic value of a deep learning-based chest radiographic age (hereafter, CXR-Age) model in a large external test cohort of Asian individuals. Materials and Methods This single-center, retrospective study included chest radiographs from consecutive, asymptomatic Asian individuals aged 50-80 years who underwent health checkups between January 2004 and June 2018. This study performed a dedicated external test of a previously developed CXR-Age model, which predicts an age adjusted based on the risk of all-cause mortality. Adjusted hazard ratios (HRs) of CXR-Age for all-cause, cardiovascular, lung cancer, and respiratory disease mortality were assessed using multivariable Cox or Fine-Gray models, and their added values were evaluated by likelihood ratio tests. Results A total of 36 924 individuals (mean chronological age, 58 years ± 7 [SD]; CXR-Age, 60 years ± 5; 22 352 male) were included. During a median follow-up of 11.0 years, 1250 individuals (3.4%) died, including 153 cardiovascular (0.4%), 166 lung cancer (0.4%), and 98 respiratory (0.3%) deaths. CXR-Age was a significant risk factor for all-cause (adjusted HR at chronological age of 50 years, 1.03; at 60 years, 1.05; at 70 years, 1.07), cardiovascular (adjusted HR, 1.11), lung cancer (adjusted HR for individuals who formerly smoked, 1.12; for those who currently smoke, 1.05), and respiratory disease (adjusted HR, 1.12) mortality (P < .05 for all). The likelihood ratio test demonstrated added prognostic value of CXR-Age to clinical factors, including chronological age for all outcomes (P < .001 for all). Conclusion Deep learning-based chest radiographic age was associated with various survival outcomes and had added value to clinical factors in asymptomatic Asian individuals, suggesting its generalizability. Keywords: Conventional Radiography, Thorax, Heart, Lung, Mediastinum, Outcomes Analysis, Quantification, Prognosis, Convolutional Neural Network (CNN) Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Adams and Bressem in this issue.

Weight-adjusted waist index is an independent predictor of all-cause and cause-specific mortality in patients with asthma

BackgroundThere is a close relationship between obesity and the occurrence of asthma.The weight-adjusted waist index (WWI) is a relatively novel anthropometric parameter that reflects obesity. ObjectiveWe aimed to explore the association between WWI and mortality in the asthma population. MethodsWe included adult with asthma from NHANES 1999–2018. WWI = Waist circumference (cm)/square root of body weight (kg). Current asthma was determined by the participant's responses in standardized questionnaires. All-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality information was obtained by prospectively matching these data to the National Death Index. Multivariate-adjusted Cox proportional hazards regression analyses, Kaplan Meier survival analyses, restricted cubic spline (RCS) analyses, stratified analyses, and sensitivity analyses were used to clarify these associations. ResultsA total of 101,316 participants were included in the study, and 3223 were diagnosed with asthma.WWI was independently and positively associated with all-cause and all factor-specific mortality in asthma. In fully adjusted models, each unit increase in WWI was associated with 43 % (hazard ratio [HR] and 95 % confidence interval [CI] = 1.43 [1.25,1.64], p < 0.0001), 58 % (1.58 [1.25, 1.99], p < 0.001), 50 % (1.50 [1.19, 1.90], p < 0.001), and 79 % (1.79 [1.34, 2.39], p < 0.0001) increased all-cause, CVD, cancer, and respiratory disease mortality, respectively. RCS analyses showed largely linear associations between WWI and all mortality risks. Stratified analyses indicated that these associations were influenced by multiple factors, and that age was consistently the effect modifier across all associations. ConclusionsWWI is an independent predictor of all-cause, CVD, cancer, and respiratory-related mortality in the adult asthma population. These findings highlight that WWI may have novel prognostic value as a simple and easily accessible obesity parameter in asthma patients.

Short-term effects of PM2.5 components on the respiratory infectious disease: a global perspective.

Although previous research has reached agreement on the significant impact of particulate matter (PM2.5) on respiratory infectious diseases, PM2.5 acts as an aggregation of miscellaneous pollutants and the individual effect of each component has not been examined. Here, we investigate the effects of PM2.5 components, including black carbon (BC), organic carbon (OC), sulfate ion (SO4), dust, and sea salt (SS), on the morbidity and mortality of the recent respiratory disease, i.e. COVID-19. The daily data of 236 countries and provinces/states (e.g., in the United States and China) worldwide during 2020-2022 are utilized. To derive the pollutant-specific causal effects, optimal instrumental variables for each pollutant are selected from a large set of atmospheric variables. We find that one µg/m3 increase in OC increases the number of cases and death by about 3% to 6% from the mean worldwide during a lag of one day up to three days. Our findings remain consistent and robust when we change control variables such as the flight index and weather proxies, and also when applying a sine transformation to the positivity and death rate. When analyzing health effects among different areas, we find stronger impact in China, for its higher local OC concentration, as opposed to the impact in the United States. Health benefits from PM2.5 pollution reduction are comparatively high for developed regions, yet decreases in cases and deaths number are rather overt in less developing regions. Our research provides inspiration and reference for dealing with other respiratory diseases in the post-pandemic era.

Association of oral health with all-cause and cause-specific mortality in older Chinese adults: A 14-year follow-up of the Guangzhou Biobank Cohort study.

Poor oral hygiene is associated with overall wellness, but evidence regarding associations of oral health with all-cause mortality remain inconclusive. We aimed to examine the associations of oral health with all-cause and cause-specific mortality in middle-aged and older Chinese adults. 28 006 participants were recruited from 2003-2008 and followed up until 2021. Oral health was assessed by face-to-face interview and causes of death was identified via record linkage. Cox regression yielded hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment of multiple potential confounders. During an average of 14.3 years of follow-up, we found that a lower frequency of toothbrushing was associated with higher risks of all-cause mortality with a dose-response pattern (P for trend <0.001). Specially, the adjusted HR (95% CI) (vs. ≥ twice/d) was 1.16 (1.10, 1.22) (P < 0.001) for brushing once/d and 1.27 (1.00, 1.61) (P = 0.048) for < once/d. Similar associations were also found for cardiovascular disease (CVD), stroke, and respiratory disease mortality, but not for ischemic heart disease (IHD) and cancer mortality. A greater number of missing teeth was also associated with higher risks of all-cause, CVD, stroke, and respiratory disease mortality with a dose-response pattern (all P for trend <0.05). The association of missing teeth with all-cause mortality was stronger in lower-educated participants. Both less frequent toothbrushing and a greater number of missing teeth were associated with higher risks of all-cause, CVD, stroke, and respiratory disease mortality, showing dose-response patterns, but not with IHD and cancer mortality. Moreover, the dose-response association of missing teeth with all-cause mortality was stronger in lower-educated participants.

Impact of global smoking prevalence on mortality: a study across income groups

BackgroundSmoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments, respiratory conditions, stroke, and lung cancer. This study aims to analyse the impact of smoking on global deaths, and its association with mortality across the main income groups.MethodsThe comprehensive analysis spans 199 countries and territories from 1990 to 2019. The study categorises countries into four income groups: high income, upper middle income, lower middle income, and low income.ResultsThe findings underscore the profound impact of global tobacco smoking on mortality. Notably, cardiovascular disease mortality is notably affected in both upper-middle-income and high-income groups. Chronic respiratory disease mortality rates show a significant impact across all income groups. Moreover, stroke-related mortality is observed in the lower-middle, upper-middle, and high-income groups. These results highlight the pervasive influence of smoking prevalence on global mortality, affecting individuals across various socioeconomic levels.ConclusionThe study underscores the critical implications of smoking on mortality rates, particularly in high-income countries. It emphasises the urgency of targeted interventions in these regions to address the specific challenges posed by tobacco smoking on public health. Policy recommendations include implementing prohibitive measures extending to indoor public areas such as workplaces and public transportation services. Furthermore, allocating funds for research on tobacco and health, is imperative to ensure policymakers are consistently informed about emerging facts and trends in this complex domain.