Chronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRDrelated or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.
Bibliographical noteFunding Information:
New York, New York (Elizabeth C. Oelsner, R. Graham Barr); Division of Nutritional Sciences, Weill Cornell Medical College, Ithaca, New York (Patricia A. Cassano); Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina (David Couper); Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona (Paul L. Enright); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (Aaron R. Folsom, David R. Jacobs, Jr.); Hankinson Consulting, Inc., Athens, Georgia (John Hankinson); Department of Medicine (Pulmonary and Critical Care), Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Ravi Kalhan, Lewis J. Smith); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York (Robert Kaplan); Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington (Richard Kronmal); Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado, Denver, Colorado (Leslie Lange); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina (Laura R. Loehr); National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina (Stephanie J. London); Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York (Ana Navas Acien); Department of Epidemiology, Pitt Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Anne B. Newman); Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts (George T. O’Connor); Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York (Joseph E. Schwartz); Department of Psychiatry and Behavioral Sciences, School of Medicine, Stony Brook University, Stony Brook, New York (Joseph E. Schwartz); Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Fawn Yeh); Jackson Heart Study, Jackson State University, Jackson, Mississippi (Stanford Mwasongwe); Jackson Heart Study, Undergraduate Training and Education Center, Tougaloo College, Tougaloo, Mississippi (Wendy B. White); and Division of Pulmonary and Critical Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Sachin Yende). This work was funded by numerous grants from the National Institutes of Health. The NHLBI Pooled Cohorts Study effort is funded by the National Heart, Lung, and Blood Institute (grants K23-HL-130627, R21-HL-129924, and R21-HL121457). The Atherosclerosis Risk in Communities Study has been funded by the National Heart, Lung, and Blood Institute (contracts HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN2682017000021). The Coronary Artery Risk Development in Young Adults Study has been funded by the National Heart, Lung, and Blood Institute (contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C) and the Intramural Research Program of the National Institute on Aging. The Cardiovascular Health Study has been funded by the National Heart, Lung, and Blood Institute (contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and grant U01HL080295), with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by the National Institute on Aging (grant R01AG023629). The Framingham Heart Study—Offspring Cohort has been funded by the National Heart, Lung, and Blood Institute (contracts N01-HC-25195 and HHSN268201500001I). The Health, Aging and Body Composition Study has been funded by the National Institute on Aging (contracts N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106 and grant R01-AG028050) and the National Institute of Nursing Research (grant R01-NR012459). The Hispanic Community Health Study/Study of Latinos has been funded by the National Heart, Lung, and Blood Institute (contracts HHSN268201300001I/N01-HC-65233 to the University of North Carolina, HHSN268201300004I/N01-HC-65234 to the University of Miami, HHSN268201300002I/N01-HC-65235 to the Albert Einstein College of Medicine, HHSN268201300003I to the University of Illinois at Chicago, N01-HC-65236 to Northwestern University, and HHSN268201300005I/N01-HC-65237 to San Diego State University). The following Institutes/Centers/Offices have contributed to the Study through a transfer of funds to the National Heart, Lung, and Blood Institute: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, NIH Institution—Office of Dietary Supplements. The Jackson Heart Study has been funded by National Heart, Lung, and Blood Institute and National Institute for Minority Health and Health Disparities (contracts HHSN268201300049C and HHSN268201300050C to Jackson State University, HHSN268201300048C to Tougaloo College, and HHSN268201300046C and HHSN268201300047C to the University of Mississippi Medical Center). The Multi-Ethnic Study of Atherosclerosis has been funded by the National Heart, Lung, and Blood Institute (contracts RC1-HL-100543, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 and grants R01-HL-077612 and R01-HL-093081). This publication was also developed under a STAR research assistance agreement (no. RD831697) (MESA Air), awarded by the US Environmental Protection Agency. The Strong Heart Study has been funded by the National Heart, Lung, and Blood Institute (cooperative agreement grants U01-HL41642, U01-HL41652, U01-HL41654, U01-HL65520,
and U01-HL65521 and research grants R01-HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319). This work was also funded by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences. We thank the other investigators, the staff, and the participants of all 9 cohorts for their valuable contributions. In particular, we thank the following study personnel who were instrumental to the accomplishment of this work: Pramod Anugu, Karen Hansen, Nancy Heard-Costa, Hunter Holbrook, Erika Enright, Lucia Juarez, Karen Mutalnik, Lisa Reeves, Linda Sellers, Greta Lee Splansky, Karen D. Hinckley Stukovsky, Kayleen Williams, Anthony Wilsdon, David Vu, Jiayi Xu, Marston Youngblood, and Ying Zhang. Preliminary data were presented as an abstract at the American Thoracic Society 2017 International Conference in May 19–24, 2017, Washington, DC, and published in abstract form (Am J Respir Crit Care Med. 2017;195: A3670).
- Atherosclerosis Risk in Communities
- cohort studies
- spirometry Abbreviations