A cohort study of forced vital capacity, airway obstruction and survival in the multinational Burden of Obstructive Lung Disease (BOLD) study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
In the USA, higher forced vital capacity (FVC) is linked with longer survival, and FVC is associated with survival independently of ethnicity. The implications for the low FVC values in parts of Asia and Africa are unknown.
Methods
We used data from 16 sites of the multinational Burden of Obstructive Lung Disease (BOLD) study that completed follow-up of participants between 2019 and 2021 and reported at least five deaths between baseline and follow-up. We assessed the association between mortality and FVC and one-second Forced Expiratory Volume (FEV1)/FVC ratio within each site using Cox proportional hazards models. These models were adjusted for age, smoking, height and weight. Effect estimates from all sites were combined using meta-analysis. Systematic regional differences were investigated.
Results
Of 9,927 study participants with follow-up data, 1,120 (11.3%) had died (mean follow-up = 8.7 years, standard deviation (SD) = 3.3 years). Baseline post-bronchodilator FVC and FEV1/FVC were inversely associated with mortality. When both FVC and FEV1/FVC were mutually adjusted for each other, the decreased mortality rates were more pronounced for each standard deviation higher FVC at baseline (44% (95% confidence interval (CI): 25%, 58%) for men and 28% (95%CI: 11%, 41%) for women) than for FEV1/FVC at baseline (14% (95% CI: 8%, 20%) for men and 7% (95% -10%, 21%) for women). The probability of true regional differences was low.
Conclusions
People with a higher FVC adjusted for age, sex and height have a longer survival. Regional adjustments to lung function standards are inappropriate when assessing prognosis.
In the USA, higher forced vital capacity (FVC) is linked with longer survival, and FVC is associated with survival independently of ethnicity. The implications for the low FVC values in parts of Asia and Africa are unknown.
Methods
We used data from 16 sites of the multinational Burden of Obstructive Lung Disease (BOLD) study that completed follow-up of participants between 2019 and 2021 and reported at least five deaths between baseline and follow-up. We assessed the association between mortality and FVC and one-second Forced Expiratory Volume (FEV1)/FVC ratio within each site using Cox proportional hazards models. These models were adjusted for age, smoking, height and weight. Effect estimates from all sites were combined using meta-analysis. Systematic regional differences were investigated.
Results
Of 9,927 study participants with follow-up data, 1,120 (11.3%) had died (mean follow-up = 8.7 years, standard deviation (SD) = 3.3 years). Baseline post-bronchodilator FVC and FEV1/FVC were inversely associated with mortality. When both FVC and FEV1/FVC were mutually adjusted for each other, the decreased mortality rates were more pronounced for each standard deviation higher FVC at baseline (44% (95% confidence interval (CI): 25%, 58%) for men and 28% (95%CI: 11%, 41%) for women) than for FEV1/FVC at baseline (14% (95% CI: 8%, 20%) for men and 7% (95% -10%, 21%) for women). The probability of true regional differences was low.
Conclusions
People with a higher FVC adjusted for age, sex and height have a longer survival. Regional adjustments to lung function standards are inappropriate when assessing prognosis.
Date Issued
2026-06-01
Date Acceptance
2026-05-13
Citation
International Journal of Epidemiology, 2026, 55 (3)
ISSN
0300-5771
Publisher
Oxford University Press
Journal / Book Title
International Journal of Epidemiology
Volume
55
Issue
3
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1093/ije/dyag093
Subjects
International Epidemiological Association survival analysis
vital capacity
airflow obstruction
multinational
lung function
Publication Status
Published
Article Number
ARTN dyag093
Date Publish Online
2026-06-07