Abstract
Background: Spirometric lung function impairment is an independent predictor of respiratory and cardiovascular disease, and mortality across a broad range of socioeconomic backgrounds and environmental settings. No contemporary studies have explored these relationships in a predominantly regional/remote First Nations population, whose health outcomes are worse than for non-First Nations populations, and First Nations people living in urban centres.
Methods: This was a retrospective cohort study of 1,734 adults (1,113 First Nations) referred to specialist respiratory outreach clinics in the state of Queensland, Australia from February 2012 to March 2020. Regression modelling was used to test associations between lung function and mortality and cardiovascular disease.
Findings: At the time of analysis (August 2020), 189 patients had died: 88 (47%) from respiratory causes and 38 (20%) from cardiovascular causes. When compared to patients with forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) Z-scores of >0 to -1, patients with Z-scores <-1 were at elevated mortality risk (HR=3•2, 95%CI 1•4-7•4; HR=2•6, 95%CI 1•3-5•1), and elevated cardiovascular disease risk (OR=1•5, 95%CI 1•1-2•2; OR=1•6, 95%CI 1•2-2•3). FEV1/FVC% Z-scores <-1 were associated with increased overall mortality (HR=1•6, 95%CI 1•1-2•3), but not cardiovascular disease (OR=1•1, 95%CI 0•8-1•4). These associations were not affected by First Nations status.
Interpretation: Reduced lung function even within the clinically normal range is associated with increased mortality, and cardiovascular disease in First Nations Australians. These findings highlight the importance of lung function optimisation and inform the need for future investment to improve outcomes in First Nations populations. Funding: None.
| Original language | English |
|---|---|
| Article number | 100188 |
| Number of pages | 8 |
| Journal | The Lancet Regional Health - Western Pacific |
| Volume | 13 |
| Early online date | 5 Jul 2021 |
| DOIs | |
| Publication status | Published - Aug 2021 |
Bibliographical note
Funding Information:We acknowledge and thank the First Nations Health Workers, First Nations project officers, doctors, nurses, and clinical measurements scientists on the IROC program for their tireless efforts.
Funding Information:
The authors received no specific funding for this work. AJC is supported by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship (APP2003334), had full access to all the data in the study and had final responsibility for the decision to submit for publication. JM reports grants from the Children's Hospital Foundation (RPC0772019) during the conduct of the study. ABC reports grants from the NHMRC (APP1154302) and Children's Health Foundation (top-up #50286); other fees to the institution from work relating to being a IDMC Member of an unlicensed vaccine (GSK), and an advisory member of study design for unlicensed molecule for chronic cough (Merck) outside the submitted work. TB reports grants from during the conduct of the study; AD is a paid employee of Metro North Hospital and Health Services which also administers the Indigenous Respiratory Outreach (IROC) Program for Queensland Health, and provides clinical services to IROC clinics. KF reports grants from Various competitive funding bodies, non-financial support from Industry, occasional honorariums from various Universities, various international funding bodies, and Cochrane Clinical Answers, occasional royalty from UpToDate, outside the submitted work; and Paid employee of Metro North Hospital and Health Services which also administers the IROC program for Queensland Health. MM reports other from Children's Hospital Foundation, and grants from the NHMRC during the conduct of the study.
Publisher Copyright:
© 2021 The Authors
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
