Change in prevalence of restrictive lung impairment in the U.S. population and associated risk factors: the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 2007–2010

Abstract

BackgroundData for the U.S adult population from the National Health and Nutrition Examination Survey (NHANES) were used to evaluate risk factors for a restrictive pattern on spirometry and estimate the change in its prevalence from the 1988–1994 to 2007–2010 sampling periods. Several previous epidemiologic studies used the Global Initiative for Chronic Obstructive Lung Disease fixed forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) > 0.70 criteria for classifying restrictive pattern rather than the age-defined American Thoracic Society (ATS)/European Respiratory Society (ERS) lower limit of normal (LLN) criteria, which may lead to misclassification.MethodsSpirometry measurements from NHANES data for the 1988–1994 and 2007–2010 periods were analyzed to estimate the age-standardized prevalence of a restrictive pattern on spirometry and the change in prevalence over time for adults aged 20–79. A restrictive pattern was defined based on ATS/ERS LLN criteria as FEV1/FVC > LLN and FVC < LLN, and a moderate to more severe restrictive pattern was further evaluated using FEV1 < 70% predicted. The associations between demographic and other individual risk factors for restrictive lung impairment were examined using multivariable logistic regression models for the two consecutive time periods.ResultsThe overall age-standardized prevalence of restrictive pattern decreased significantly from 7.2% (1988–1994) to 5.4% (2007–2010) (p = 0.0013). The prevalence of moderate to more severe restrictive pattern also decreased significantly from 2.0% to 1.4% (p = 0.023). Factors positively associated with restrictive pattern on spirometry included age, female sex, white race, lower education, former and current smoking, and comorbidities including doctor-diagnosed cardiovascular disease, doctor-diagnosed diabetes, and abdominal obesity.ConclusionsThe overall prevalence of restrictive pattern and moderate to more severe restrictive pattern decreased between the 1988–1994 and 2007–2010 survey periods despite a population increase in the proportion of comorbidities associated with restrictive pattern (i.e. diabetes and abdominal obesity). This suggests a decline in individual risk factors for restrictive pattern and a need for future research.

Determinants of Restrictive Spirometric Pattern in a Sub-Saharan Urban Setting: A Cross-sectional Population-based Study

“…Prevalent heart disease was also an independent determinant of restriction in our study. This result has not been reported in other studies [9], but Kurth et al found a significant association between pulmonary restriction and cardiovascular diseases including congestive heart failure, stroke and heart attacks [10]. Cardiovascular diseases, when complicated with left heart failure can lead to pulmonary oedema, which in turn can reduce the vital capacity.…”

“…“Although to establish the diagnosis of lung restriction, a lung volume measurement is needed, we used the term restrictive spirometric pattern to design the population with a low FVC with a FEV1/FVC > lower limit of normal [LLN])” The prevalence of restrictive spirometric pattern in our study was higher than the 6.6% (fixed cut-off based) and 5.4% (LLN-based) reported respectively by Mannino et al , and Kurth et al in the general population in the USA, using data from the third National Nutrition and Health Examination Survey [8, 10]. Similarly, Scarlata et al found a prevalence of 10.9% for restrictive pattern among elderly people in the general population in Italy [3], which was by far lower than the 43.2% found among the 60 years old and above in our sample.…”

“…Across these studies, the prevalence of restrictive pattern in the general population ranged from 5.4% to 10.9% in US [8-10], to 74% in Aboriginal Australians [11]. These studies have also revealed many risk factors for restrictive pattern including high cardio-thoracic index, paralysis, diabetes mellitus and cardiovascular diseases (CVD) in the general population [9, 10]; and abdominal obesity, physical impairment, cognitive impairment and kypho-scoliosis in the elderly population [3]. …”

Work Practices and Respiratory Health Status of Appalachian Coal Miners With Progressive Massive Fibrosis

“…1,18,19 The majority of miners with spirometry results had ventilatory impairment at a level exceeding that seen within the general working U.S. population. 20,21 Miners’ ventilatory impairment included obstructive, restrictive, and mixed patterns. Smoking generally contributes to obstructive or mixed patterns of impairment, found in four and three miners, respectively.…”

Impact of chronic khat (Catha edulisForsk) chewing on pulmonary function test and oxygen saturation in humans: A comparative study

“…The predominant pathologic changes of restrictive lung diseases are found in the lung parenchyma or extrinsic to it. 25 Hence, chronic khat chewing may have a negative effect on the lung parenchyma or extraparenchymal structures. However, there is no any previous evidence relating to increased risk of restrictive lung diseases with chronic khat chewing.…”