Figures
- FIGURE 1
Schematic diagram explaining the flow of study participants. ELSA: English Longitudinal Study of Ageing; COPD: chronic obstructive pulmonary disease. #: of the remaining 7452 participants, 3726 were common in both waves yielding a final sample of 3726 participants with 4-year follow-up.
- FIGURE 2
Treatable traits associated with decline in lung function and quality of life (QoL).
Tables
- TABLE 1
List of potential treatable traits (TTs) identified from the English Longitudinal Study of Ageing (ELSA) cohort
TT Diagnostic criteria Pulmonary Airflow limitation FEV1/FVC <0.7 Chronic bronchitis Physician diagnosis/self-report# Chronic sputum production Sputum with coughing (≥3 months·year−1) Breathlessness mMRC dyspnoea scale Frequent chest infections Self-report Extra-pulmonary Osteoporosis Physician diagnosis/self-report CVD¶ Physician diagnosis/self-report Arthritis Physician diagnosis/self-report Diabetes Physician diagnosis/self-report Cancer+ Physician diagnosis/self-report Psychiatric problems§ Physician diagnosis/self-report Depression CES-D scale Underweight BMI <18.5 kg·m−2 Obesity BMI ≥30 kg·m−2 Sarcopenia Handgrip strength <27 kg (males) and <16 kg (females) Systemic inflammation CRP >3 mg·L−1 Anaemia Hb <140 g·L−1 (men) or <120 g·L−1 (women) Disability Self-reported limitations in basic ADL and IADL Behavioural traits/lifestyle-risk factors Current smoking Interview/self-report Physical inactivityƒ Interview/self-report Poor family and social support Interview/self-report FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; mMRC: modified Medical Research Council; CVD: cardiovascular disease; CES-D: Centre for Epidemiological Studies-Depression; BMI: body mass index; CRP: C-reactive protein; Hb: haemoglobin; ADL: activities of daily living; IADL: instrumental activities of daily living. #: self-reported by the participants; ¶: including high blood pressure (BP), angina, myocardial infarction, heart attack, high cholesterol, congestive heart failure, stroke and heart murmur or abnormal heart rhythm; +: including cancers of the lung and breast, as well as colorectal cancers, lymphoma, leukaemia and melanoma; §: including hallucinations, anxiety, emotional problems, schizophrenia, psychosis, mood swings and bipolar disorder; ƒ: no mild, moderate or vigorous activity per week.
- TABLE 2
Baseline socio-demographic and clinical characteristics of the cohort
Variable COPD (n=406) Non-COPD (n=3320) p-value Male gender 186 (45.8) 1526 (46.0) 0.954 Age years 67.0 (59–73) 63.0 (57–70) <0.001 Marital status <0.001 Single/separated/widowed 153 (37.7) 938 (28.3) Living in a relationship 253 (62.3) 2382 (71.7) Ethnicity White 395 (97.3) 3272 (98.6) 0.054 Socio-economic class <0.001 Managerial and professional 108 (26.6) 1209 (36.4) Intermediate 53 (13.1) 467 (14.1) Small employers and own-account workers 44 (10.8) 388 (11.7) Lower supervisory and technical 50 (12.3) 329 (9.9) Semi-routine occupations 144 (35.5) 899 (27.1) Other 7 (1.7) 28 (0.8) Self-reported health <0.001 Excellent 36 (8.9) 577 (17.4) Very good 99 (24.4) 1140 (34.3) Good 144 (35.5) 1071 (32.3) Fair 93 (22.9) 438 (13.2) Poor 34 (8.4) 94 (2.8) Physical activity <0.001 None 25 (6.2) 118 (3.6) Mild 64 (15.8) 373 (11.2) Moderate 236 (58.1) 1684 (50.7) Vigorous 81 (20.0) 1145 (34.5) Dyspnoea <0.001 Grade 0 172 (42.4) 2519 (75.9) Grade 1 151 (37.2) 549 (16.5) Grade 2 34 (8.4) 90 (2.7) Grade 3 49 (12.1) 162 (4.9) Smoking status <0.001 Never smoker 100 (24.6) 1346 (40.5) Former smoker 160 (39.4) 1518 (45.7) Current smoker 146 (36.0) 456 (13.7) Spirometry measurements FEV1 L 1.7 (1.1–2.3) 2.5 (2.0–3.1) <0.001 FVC L 3.1 (2.3–3.8) 3.2 (2.6–4.0) 0.001 PEF L·min−1 286.5 (202.8–378.8) 385 (307.0–493.0) <0.001 FEV1 % pred 70.2 (49.5–84.6) 94.0 (83.5–104.8) <0.001 FVC % pred 92.2 (78.0–107.2) 94.4 (83.6–106.0) 0.056 Data are presented as n (%) or median (IQR). p-Values in bold are statistically significant. COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; PEF: peak expiratory flow; IQR: interquartile range (25th to 75th percentile).
- TABLE 3
Prevalence of various treatable traits (TTs) at baseline by Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity status
TT COPD Non-COPD (n=3320) p-value# Mild (n=129) Moderate (n=172) Severe (n=74) Very severe (n=31) Overall (n=406) Pulmonary Airflow limitation 129 (100) 172 (100) 74 (100) 31 (100) 406 (100) 462 (13.9) <0.001 Breathlessness 61 (47.3) 102 (59.3) 50 (67.6) 16 (51.6) 229 (56.4) 789 (23.8) <0.001 Chronic bronchitis 4 (3.1) 26 (15.1) 9 (12.2) 4 (12.9) 43 (10.6) 49 (1.5) <0.001 Chronic sputum production 29 (22.5) 59 (34.3) 22 (29.7) 10 (32.2) 120 (29.6) 221 (6.7) <0.001 Frequent chest infections 10 (7.8) 24 (14.0) 10 (13.5) 2 (6.5) 46 (11.3) 237 (7.1) 0.003 Extra-pulmonary Osteoporosis 6 (4.7) 13 (7.6) 9 (12.2) 2 (6.5) 30 (7.4) 149 (4.5) 0.010 CVD 23 (17.8) 43 (25) 18 (24.3) 8 (25.8) 92 (22.7) 742 (22.3) 0.747 Arthritis 52 (40.3) 76 (44.2) 30 (40.5) 10 (32.3) 168 (41.4) 1130 (34) 0.003 Diabetes 5 (3.9) 14 (8.1) 6 (8.1) 1 (3.2) 26 (6.4) 211 (6.4) 0.970 Cancer 8 (6.2) 15 (8.7) 5 (6.8) 1 (3.2) 29 (7.1) 225 (6.8) 0.783 Psychiatric problems 11 (8.5) 8 (4.7) 2 (2.7) 0 (0.0) 21 (5.2) 167 (5.0) 0.902 Depression 26 (20.2) 51 (29.7) 19 (25.7) 8 (25.8) 104 (25.6) 576 (17.3) <0.001 Underweight 1 (0.8) 2 (1.2) 1 (1.4) 1 (3.2) 5 (1.2) 26 (0.8) 0.202 Obesity 36 (27.9) 45 (26.2) 26 (35.1) 8 (25.8) 115 (28.3) 912 (27.5) 0.765 Sarcopenia 6 (4.7) 14 (8.1) 6 (8.1) 2 (6.5) 29 (7.1) 157 (4.7) 0.035 Systemic inflammation 44 (34.1) 79 (45.9) 35 (47.3) 11 (35.5) 168 (41.4) 985 (29.7) <0.001 Anaemia 8 (6.2) 16 (9.3) 5 (6.8) 2 (6.5) 31 (7.6) 223 (6.7) 0.473 Disability 77 (59.7) 131 (76.2) 58 (78.4) 22 (71.0) 288 (70.9) 1674 (50.4) <0.001 Behavioural/lifestyle Current smoking 33 (25.6) 73 (42.4) 27 (36.5) 13 (41.9) 146 (36.0) 458 (13.8) <0.001 Physical inactivity 3 (2.3) 12 (7.0) 10 (13.5) 0 (0.0) 25 (6.2) 118 (3.6) 0.010 Poor family and social support 27 (20.9) 37 (21.5) 14 (18.9) 8 (25.8) 86 (21.2) 574 (17.3) 0.039 Data are presented as n (%). p-Values in bold are statistically significant. COPD: chronic obstructive pulmonary disease; CVD: cardiovascular disease. #: COPD (overall) versus non-COPD.
- TABLE 4
Treatable traits (TTs) associated with decline in forced expiratory volume in 1 s (FEV1)
TT COPD Non-COPD Unadjusted Model 1# Model 2¶ Unadjusted Model 1+ Model 2§ Airflow limitation 3.046 (2.825–3.268) 2.957 (2.736–3.178) 2.976 (2.760–3.193)*** 1.821 (1.645–1.997) 2.046 (1.823–2.268) 2.018 (1.798–2.238)*** Chronic bronchitis −0.243 (−0.387 to −0.100) −0.172 (−0.273 to −0.070) −0.186 (−0.290 to −0.082)*** −0.257 (−0.412 to −0.103) −0.097 (−0.213 to 0.019) – Chronic sputum production −0.031 (−0.144 to 0.082) – – −0.046 (−0.125 to 0.032) – – Breathlessness −0.304 (−0.416 to −0.192) −0.076 (−0.147 to −0.005) −0.093 (−0.164 to −0.022)* −0.360 (−0.406 to −0.314) −0.112 (−0.146 to −0.078) −0.112 (−0.144 to −0.080)*** Frequent chest infections −0.043 (−0.188 to 0.103) – – −0.063 (−0.131 to 0.006) −0.031 (−0.082 to 0.020) – Osteoporosis −0.383 (−0.540 to −0.226) −0.056 (−0.182 to 0.069) – −0.492 (−0.571 to −0.413) −0.039 (−0.037 to 0.115) – CVD −0.024 (−0.129 to 0.080) – – −0.111 (−0.155 to −0.068) 0.012 (−0.018 to 0.042) – Arthritis −0.072 (−0.180 to 0.035) – – −0.248 (−0.295 to −0.200) 0.046 (0.014–0.079) 0.039 (0.007–0.071)* Diabetes −0.135 (−0.306 to 0.036) – – −0.141 (−0.228 to −0.053) −0.078 (−0.142 to −0.015) −0.082 (−0.144 to −0.020)** Cancer 0.062 (−0.153 to 0.276) – – −0.165 (−0.245 to −0.084) −0.006 (−0.067 to 0.055) – Psychiatric problems 0.196 (−0.028 to 0.420) −0.066 (−0.240 to 0.107) – 0.102 (−0.010 to 0.214) 0.011 (−0.057 to 0.078) – Depression −0.149 (−0.263 to −0.036) 0.007 (−0.066 to 0.080) – −0.232 (−0.285 to −0.178) −0.019 (−0.052 to 0.015) – Underweight −0.682 (−0.947 to −0.417) −0.207 (−0.370 to −0.043) −0.216 (−0.373 to −0.058)** −0.174 (−0.470 to 0.123) – – Obesity −0.051 (−0.162 to 0.060) – – −0.140 (−0.190 to −0.091) −0.110 (−0.145 to −0.074) −0.104 (−0.139 to −0.069)*** Sarcopenia −0.402 (−0.537 to −0.267) −0.137 (−0.240 to −0.034) −0.162 (−0.262 to −0.061)** −0.555 (−0.634 to −0.476) −0.120 (−0.177 to −0.063) −0.114 (−0.167 to −0.060)*** Systemic inflammation −0.061 (−0.171 to 0.050) – – −0.272 (−0.323 to −0.221) −0.076 (−0.108 to −0.044) −0.081 (−0.112 to −0.050)*** Anaemia −0.001 (−0.167 to 0.170) – – 0.049 (−0.037 to 0.135) – – Disability −0.244 (−0.344 to −0.143) −0.038 (−0.100 to 0.024) – −0.277 (−0.318 to −0.235) −0.031 (−0.062 to −0.001) −0.036 (−0.064 to −0.009)* Current smoking −0.092 (−0.201 to 0.017) −0.218 (−0.294 to −0.142) −0.228 (−0.304 to −0.153)*** −0.213 (−0.280 to −0.145) −0.192 (−0.246 to −0.138) −0.202 (−0.254 to −0.150)*** Physical inactivity −0.273 (−0.448 to −0.097) −0.085 (−0.197 to 0.026) – −0.344 (−0.440 to −0.248) −0.108 (−0.185 to −0.030) −0.096 (−0.169 to −0.023)* Poor family and social support 0.093 (−0.034 to 0.220) – – 0.024 (−0.036 to 0.085) – – Data are presented as β (95% CI). Values in bold are statistically significant. COPD: chronic obstructive pulmonary disease; CVD: cardiovascular disease; CI: confidence interval. #: adjusted for sex, age, marital status, socioeconomic class and TTs (p<0.1) from the univariate analyses; ¶: adjusted for sex, age and TTs (p<0.1) from the multivariate analyses; +: adjusted for sex, age, marital status, ethnicity, socioeconomic class and TTs (p<0.1) from the univariate analyses; §: adjusted for sex, age, marital status, ethnicity, socioeconomic class and TTs (p<0.1) from the multivariate analyses. *: p<0.05; **: p<0.01; ***: p<0.001.
- TABLE 5
Treatable traits (TTs) associated with decline in quality of life (QoL)
TT COPD Non-COPD Unadjusted Model 1# Model 2¶ Unadjusted Model 1+ Model 2§ Airflow limitation −3.63 (−8.17 to 0.91) – – −4.02 (−5.77 to −2.28) −0.366 (−1.95 to 1.21) – Chronic bronchitis −3.28 (−5.46 to −1.09) −2.81 (−4.67 to −0.95) −2.87 (−4.65 to −1.08)** −4.09 (−6.24 to −1.95) −0.68 (−2.39 to 1.03) – Chronic sputum production −2.10 (−3.49 to −0.72) −0.96 (−2.35 to 0.43) – −3.96 (−4.93 to −2.99) −0.88 (−1.79 to 0.03) −0.96 (−1.86 to −0.06)* Breathlessness −3.64 (−4.91 to −2.38) −0.76 (−2.03 to 0.50) – −4.53 (−5.11 to −3.95) −1.76 (−2.30 to −1.22) −1.76 (−2.29 to −1.23)*** Frequent chest infections −2.10 (−4.43 to 0.23) −1.25 (−3.13 to 0.63) – −0.71 (−1.53 to 0.10) −0.19 (−0.94 to 0.55) – Osteoporosis −0.83 (−2.86 to 1.20) – – −2.85 (−3.95 to −1.74) −1.58 (−2.63 to −0.52) −1.57 (−2.62 to −0.52)** CVD −2.62 (−3.93 to −1.31) −1.34 (−2.60 to −0.08) −1.69 (−2.90 to −0.48)** −2.03 (−2.51 to −1.56) −1.16 (−1.57 to −0.76) −1.17 (−1.57 to −0.77)*** Arthritis −3.52 (−4.80 to −2.23) −1.41 (−2.67 to −0.15) −1.52 (−2.76 to −0.28)* −3.05 (−3.55 to −2.56) −1.28 (−1.71 to −0.84) −1.28 (−1.72 to −0.85)*** Diabetes −3.56 (−5.42 to −1.69) −1.40 (−3.17 to 0.37) – −2.56 (−3.50 to −1.62) −0.81 (−1.64 to 0.03) −0.81 (−1.64 to 0.02) Cancer −1.40 (−4.26 to 1.47) – – −0.22 (−1.21 to 0.77) – – Psychiatric problems −0.68 (−3.23 to 1.88) – – −0.15 (−1.12 to 0.83) – – Depression −7.88 (−9.38 to −6.38) −7.08 (−8.73 to −5.44) −7.19 (−8.81 to −5.57)*** −8.70 (−9.38 to −8.01) −5.87 (−6.54 to −5.20) −5.82 (−6.48 to −5.15)*** Underweight −0.71 (−3.51 to 2.10) – – 0.62 (−3.49 to 4.74) – – Obesity −0.27 (−1.70 to 1.16) – – −1.95 (−2.51 to −1.40) −0.58 (−1.09 to −0.07) −0.51 (−1.01 to −0.02)* Sarcopenia −3.35 (−5.16 to −1.54) −1.32 (−3.49 to 0.84) – −4.24 (−5.24 to −3.24) −1.32 (−2.26 to −0.38) −1.34 (−2.28 to −0.41)** Systemic inflammation −0.93 (−2.43 to 0.57) – – −1.13 (−1.69 to −0.57) 0.11 (−0.34 to 0.56) – Anaemia −3.15 (−5.55 to −0.75) −2.61 (−4.42 to −0.79) −3.28 (−5.06 to −1.49)*** −1.42 (−2.27 to −0.57) −0.88 (−1.56 to −0.20) −0.90 (−1.57 to −0.23)** Disability −3.81 (−4.95 to −2.67) −2.30 (−3.59 to −1.01) −2.83 (−4.06 to −1.60)*** −4.15 (−4.62 to −3.68) −0.82 (−1.25 to −0.39) −0.80 (−1.22 to −0.37)*** Current smoking −1.44 (−2.82 to −0.05) −1.31 (−2.66 to 0.04) −1.12 (−2.40 to 0.17) −2.69 (−3.52 to −1.85) −1.92 (−2.70 to −1.14) −1.90 (−2.67 to −1.13)*** Physical inactivity −3.47 (−5.48 to −1.46) 1.35 (−0.68 to 3.37) – −4.90 (−6.14 to −3.67) −1.43 (−2.55 to −0.32) −1.41 (−2.50 to −0.31)* Poor family and social support −5.44 (−7.05 to −3.83) −5.25 (−6.82 to −3.68) −5.12 (−6.65 to −3.59)*** −5.58 (−6.29 to −4.88) −3.59 (−4.22 to −2.96) −3.57 (−4.19 to −2.95)*** Data are presented as β (95% CI). Values in bold are statistically significant. COPD: chronic obstructive pulmonary disease; CVD: cardiovascular disease; CI: confidence interval. #: adjusted for age, marital status, socioeconomic class and TTs (p<0.1) from the univariate analyses; ¶: adjusted for socioeconomic class and TTs (p<0.1) from the multivariate analyses; +: adjusted for age, marital status, socioeconomic class and TTs (p<0.1) from the univariate analyses; §: adjusted for age, socioeconomic class and TTs (p<0.1) from the multivariate analyses. *: p<0.05; **: p<0.01; ***: p<0.001.
Supplementary Material
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Supplementary material 00934-2020.SUPPLEMENT
Supplementary tables 00934-2020.SUPPLEMENTARY_TABLES
