To determine whether the GOLD classification criteria predict incident cases of lung cancer in a cohort of subjects followed for up to 11 years.
We analyzed data from 15,759 adult participants, aged 43–66 years at baseline, in the Atherosclerosis Risk in Communities (ARIC) study. All baseline and follow-up data were available for 15,432 (97.9%) of the initial participants. We excluded 851 subjects (5.4%) who stated they had a cancer diagnosis at the baseline evaluation, resulting in 14,581 subjects in our final cohort. We classified subjects using the GOLD criteria for COPD, and added a “restricted” category (FEV1/FVC > 70% and FVC < 80% predicted). Our endpoint of interest was either the first hospitalization that listed a lung cancer diagnosis (ICD-9 code 162) or a death listing lung cancer. We used Cox proportional hazard models to determine the risk of impaired lung function on incident lung cancer, after adjusting for age, race, sex and smoking status.
170 (1.2%) of subjects developed lung cancer by the end of 1997. The rate of lung cancer development ranged from 0.4 per 1000 person years among normal subjects to 11.7 /1000 among subjects with GOLD 3 or 4 COPD (TableDiseasen%Lung CancerPerson YearsLung Ca Rate/1000 Person yearsHazard RatioGOLD 3/41771.116136611.711.9 (6.3, 22.5)GOLD 28865.73876315.06.1 (3.6, 10.2)GOLD 1214113.954190782.83.5 (2.2, 5.8)GOLD 0239915.523216001.12.2 (1.3, 3.9)Restricted10917.11396051.42.6 (1.3, 5.1)Normal788751.126723970.41.0Total145811701316771.3). After adjusting for covariates, all GOLD categories, along with the restricted category, predicted a higher risk of incident lung cancer (Table).
The GOLD classification system of COPD predicts incident lung cancer in this cohort of middle-aged Americans followed for up to 11 years.
Pulmonary function testing may be useful in the clinical evaluation of patients risk for the subsequent development of lung cancer.
D.M. Mannino, None.