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Period and cohort effects: consequences on spirometric lung function in Norway during the 20th century

Lucia Cestelli, Ane Johannessen, Knut Stavem, Amund Gulsvik, Rune Nielsen
ERJ Open Research 2022 8: 00302-2022; DOI: 10.1183/23120541.00302-2022
Lucia Cestelli
1Department of Clinical Science, University of Bergen, Bergen, Norway
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  • For correspondence: lucia.cestelli@uib.no
Ane Johannessen
2Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Knut Stavem
3Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
4Institute of Clinical Medicine, University of Oslo, Oslo, Norway
5Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Amund Gulsvik
1Department of Clinical Science, University of Bergen, Bergen, Norway
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Rune Nielsen
1Department of Clinical Science, University of Bergen, Bergen, Norway
6Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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  • FIGURE 1
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    FIGURE 1

    Mean forced expiratory volume in 1 s (FEV1) z-scores with 95% confidence intervals of healthy subjects in surveys conducted in different periods of time. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations. BCRDS: Bergen Chronic Respiratory Disease Survey (1965–1970); PSWON: Pneumoconiosis Survey of Western Norway (1988–1990); HCRHS: Hordaland County Respiratory Health Survey (1996–1997); BD-HUSK: Bronchodilatation Survey of the Hordaland Health Study (1998–1999).

  • FIGURE 2
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    FIGURE 2

    Mean forced vital capacity (FVC) z-scores with 95% confidence intervals of healthy subjects in surveys conducted in different periods of time. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations. BCRDS: Bergen Chronic Respiratory Disease Survey (1965–1970); PSWON: Pneumoconiosis Survey of Western Norway (1988–1990); HCRHS: Hordaland County Respiratory Health Survey (1996–1997); BD-HUSK: Bronchodilatation Survey of the Hordaland Health Study (1998–1999).

  • FIGURE 3
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    FIGURE 3

    Adjusted predictions of forced expiratory volume in 1 s (FEV1) z-scores with 95% confidence intervals according to birth cohort, for subjects without a history of smoking, lung diseases and respiratory symptoms. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations. Birth cohorts: 1894–1904, 1905–1914, 1915–1924, 1925–1934, 1935–1944, 1945–1954, 1955–1964, 1965–1969.

  • FIGURE 4
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    FIGURE 4

    Adjusted predictions of forced vital capacity (FVC) z-scores with 95% confidence intervals according to birth cohort, for subjects without a history of smoking, lung diseases and respiratory symptoms. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations. Birth cohorts: 1894–1904, 1905–1914, 1915–1924, 1925–1934, 1935–1944, 1945–1954, 1955–1964, 1965–1969.

Tables

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  • TABLE 1

    Characteristics and spirometry values of participants in the study population, stratified by sex and by survey

    BCRDSPSWONHCRHSBD-HUSKTotal
    Survey years1965–19701988–19901996–19971998–19991965–1999
    Birth years1894–19431944–19581914–19691925–1951#1894–1969
    Number of subjects561626 0921993276536 466
    Males
     Subjects2524 (45)26 092 (100)814 (41)1101 (40)30 531 (84)
     Age years47.3±13.938.2±4.350.5±16.068.3±9.340.4±9.0
     Height cm174.6±6.6178.8±6.3177.5±6.9175.7±6.6178.3±6.5
     Smoking status
      Nonsmoker392 (16)8133 (31)267 (33)247 (23)9039 (30)
      Ex-smoker461 (18)6395 (25)274 (34)640 (59)7770 (26)
      Current smoker1671 (66)11 488 (44)273 (34)206 (19)13 638 (45)
     Pack-years13.8±13.816.1±9.417.4±14.720.9±18.116.1±10.6
     Education
      <11 years982 (41)3476 (14)158 (20)229 (21)4845 (16)
      11–13 years1110 (47)15 450 (60)459 (57)550 (50)17 569 (59)
      14–20+ years292 (12)6785 (26)189 (23)311 (29)7577 (25)
     FEV1, L3.88±1.054.28±0.623.68±0.952.90±0.744.18±0.74
     FEV1, z-score0.08±1.34−0.08±0.96−0.37±1.10−0.55±1.10−0.09±1.02
     FVC, L4.90±1.125.40±0.764.73±1.063.87±0.825.29±0.87
     FVC, z-score0.13±1.140.04±0.90−0.26±0.95−0.52±0.970.02±0.93
    Females
     Subjects3092 (55)-1179 (59)1664 (60)5935 (16)
     Age years48.3±14.0-50.6±15.060.8±12.252.3±14.8
     Height cm161.2±6.0-164.7±6.2163.3±6.3162.5±6.3
     Smoking status
      Nonsmoker1925 (62)-533 (45)782 (48)3240 (55)
      Ex-smoker144 (5)-274 (23)454 (28)872 (15)
      Current smoker1023 (33)-372 (32)396 (24)1791 (30)
     Pack-years6.6±6.2-11.9±10.113.3±11.09.9±9.4
     Education
      <11 years1717 (58)-264 (23)438 (27)2419 (42)
      11–13 years1062 (36)-649 (56)862 (53)2573 (44)
      14–20+ years198 (7)-253 (22)339 (21)790 (14)
     FEV1, L2.78±0.73-2.74±0.672.36±0.602.66±0.71
     FEV1, z-score0.10±1.29-−0.20±1.04−0.37±1.06−0.09±1.20
     FVC, L3.38±0.79-3.43±0.763.00±0.693.28±0.78
     FVC, z-score−0.02±1.13-−0.16±0.93−0.38±0.92−0.15±1.05

    Variables are presented as mean±sd or n (%) as appropriate. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations. BCRDS: Bergen Chronic Respiratory Disease Survey; PSWON: Pneumoconiosis Survey of Western Norway; HCRHS: Hordaland County Respiratory Health Survey; BD-HUSK: Bronchodilatation Survey of the Hordaland Health Study; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity. #: two birth cohorts: 1925–1927 and 1950–1951.

    • TABLE 2

      Characteristics and spirometry values of participants in the healthy subgroup, stratified by sex and by survey

      BCRDSPSWONHCRHSBD-HUSKTotal
      Survey years1965–19701988–19901996–19971998–19991965–1999
      Birth years1894–19431944–19581914–19691925–1951#1894–1969
      Number of subjects¶1438 (26)5674 (22)409 (21)521 (19)8042 (22)
      Males
       Subjects328 (23)5674 (100)154 (38)136 (26)6292 (78)
       Age years40.8±14.437.8±4.444.8±14.964.5±11.538.7±7.3
       Height cm175.5±6.6179.3±6.3179.4±6.8176.5±6.5179.0±6.4
       Education
        <11 years81 (26)405 (7)11 (7)16 (12)513 (8)
        11–13 years149 (47)2922 (52)77 (50)60 (44)3208 (52)
        14–20+ years87 (27)2277 (41)65 (42)59 (44)2488 (40)
       FEV1, L4.43±0.924.42±0.594.14±0.773.38±0.614.39±0.64
       FEV1, z-score0.71±1.110.11±0.92−0.01±0.880.06±0.910.14±0.94
       FVC, L5.35±1.045.50±0.765.18±0.944.32±0.775.46±0.80
       FVC, z-score0.48±1.000.12±0.89−0.03±0.81−0.09±0.840.13±0.90
      Females
       Subjects1110 (77)-255 (62)385 (74)1750 (22)
       Age years47.6±14.1-50.7±15.261.7±12.351.1±15.0
       Height cm161.5±6.1-164.8±6.2163.0±6.3162.3±6.3
       Education
        <11 years559 (52)-48 (19)89 (23)696 (41)
        11–13 years420 (39)-118 (47)194 (51)732 (43)
        14–20+ years101 (9)-86 (34)98 (26)285 (17)
       FEV1, L2.91±0.68-2.87±0.642.47±0.552.81±0.67
       FEV1, z-score0.39±1.16-0.14±0.900.01±0.910.27±1.09
       FVC, L3.50±0.73-3.55±0.763.09±0.653.42±0.74
       FVC, z-score0.19±1.03-0.10±0.84−0.11±0.830.11±0.97

      Variables are presented as mean±sd or n (%) as appropriate. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations. BCRDS: Bergen Chronic Respiratory Disease Survey; PSWON: Pneumoconiosis Survey of Western Norway; HCRHS: Hordaland County Respiratory Health Survey; BD-HUSK: Bronchodilatation Survey of the Hordaland Health Study; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity. #: two birth cohorts: 1925–1927 and 1950–1951; ¶: percentage refers to the original population.

      • TABLE 3

        Estimated changes of forced expiratory volume in 1 s z-scores with birth cohort in the total population

        MalesFemales
        Birth cohortnCoefficient95% CIp-valuenCoefficient95% CIp-value
        1894–1904469---640---
        1905–1914517−0.05(−0.18–0.08)0.4407200.19(0.06–0.31)<0.001
        1915–19246740.19(0.07–0.31)<0.0017900.31(0.19–0.43)<0.001
        1925–193415520.51(0.39–0.63)<0.00115800.61(0.49–0.74)<0.001
        1935–194421250.74(0.61–0.86)<0.0017200.66(0.53–0.79)<0.001
        1945–195417 8380.66(0.54–0.79)<0.00110950.57(0.42–0.73)<0.001
        1955–196472230.59(0.46–0.72)<0.0012500.48(0.28–0.68)<0.001
        1965–19691330.59(0.37–0.80)<0.0011400.55(0.32–0.79)<0.001

        Linear mixed-effect models with random effects at the survey level, adjusted for smoking status, pack-years, education, lung diseases and respiratory symptoms. Birth cohort reference category = 1894–1904. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations.

        • TABLE 4

          Estimated changes of forced vital capacity z-scores with birth cohort in the total population

          MalesFemales
          Birth cohortnCoefficient95% CIp-valuenCoefficient95% CIp-value
          1894–1904469---640---
          1905–19145170.00(−0.12–0.12)0.9907200.13(0.02–0.24)0.020
          1915–19246740.14(0.03–0.26)0.0107900.28(0.18–0.39)<0.001
          1925–193415520.43(0.32–0.54)<0.00115800.54(0.43–0.66)<0.001
          1935–194421250.61(0.50–0.73)<0.0017200.53(0.41–0.65)<0.001
          1945–195417 8380.60(0.48–0.72)<0.00110950.50(0.36–0.64)<0.001
          1955–196472230.61(0.49–0.73)<0.0012500.50(0.32–0.68)<0.001
          1965–19691330.70(0.50–0.90)<0.0011400.64(0.43–0.85)<0.001

          Linear mixed-effect models with random effects at the survey level, adjusted for smoking status, pack-years, education, lung diseases and respiratory symptoms. Birth cohort reference category = 1894–1904. Z-scores calculated according to Global Lung Function Initiative (GLI-2012) equations.

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          Period and cohort effects: consequences on spirometric lung function in Norway during the 20th century
          Lucia Cestelli, Ane Johannessen, Knut Stavem, Amund Gulsvik, Rune Nielsen
          ERJ Open Research Oct 2022, 8 (4) 00302-2022; DOI: 10.1183/23120541.00302-2022

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          Period and cohort effects: consequences on spirometric lung function in Norway during the 20th century
          Lucia Cestelli, Ane Johannessen, Knut Stavem, Amund Gulsvik, Rune Nielsen
          ERJ Open Research Oct 2022, 8 (4) 00302-2022; DOI: 10.1183/23120541.00302-2022
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