Environmental exposures and systemic hypertension are risk factors for decline in lung function.
BACKGROUND
Chronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries.


METHODS
We collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged ≥35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline.


RESULTS
Mean±SD enrolment age was 55.4±12.5 years, 49.2% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9% (95% CI 15.7% to 36.1%), 21.3% (11.1% to 31.5%) and 15.7% (3.7% to 26.9%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1% (95% CI% 29.8% to 54.4%), 36.0% (23.7% to 48.2%) and 15.8% (2.6% to 28.9%) of the overall mean annual decline, respectively.


CONCLUSION
Urbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence.
['Miele|Catherine H|CH|', 'Grigsby|Matthew R|MR|', 'Siddharthan|Trishul|T|0000-0001-9914-1839', 'Gilman|Robert H|RH|', 'Miranda|J Jaime|JJ|', 'Bernabe-Ortiz|Antonio|A|', 'Wise|Robert A|RA|', 'Checkley|William|W|', '|||']
D000328:Adult D000368:Aged D000531:Altitude D002908:Chronic Disease D015897:Comorbidity D003906:Developing Countries D004781:Environmental Exposure D005260:Female D005541:Forced Expiratory Volume D006801:Humans D006973:Hypertension D008137:Longitudinal Studies D008171:Lung Diseases D008297:Male D008875:Middle Aged D010568:Peru D012111:Residence Characteristics D012307:Risk Factors D014507:Urbanization
copd epidemiology not applicable tobacco and the lung