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Original Research: Occupational and Environmental Lung Diseases |

Prevalence, Clinical Profile, Iron Status, and Subject-Specific Traits for Excessive Erythrocytosis in Andean Adults Living Permanently at 3,825 Meters Above Sea LevelExcessive Erythrocytosis in High-Altitude Peru

Aldo De Ferrari, MD; J. Jaime Miranda, MD; Robert H. Gilman, MD, DTMH; Victor G. Dávila-Román, MD; Fabiola León-Velarde, DSc; Maria Rivera-Ch, DsC; Luis Huicho, MD; Antonio Bernabé-Ortiz, MD, MPH; Robert A. Wise, MD, FCCP; William Checkley, MD, PhD; CRONICAS Cohort Study Group
Author and Funding Information

From the Division of Pulmonary and Critical Care (Drs De Ferrari and Checkley and Prof Wise), School of Medicine, Johns Hopkins University, Baltimore, MD; CRONICAS Centre of Excellence for Chronic Diseases (Drs Miranda, Bernabé-Ortiz, and Checkley and Prof Gilman) and Departamento de Medicina, Escuela de Medicina (Dr Miranda and Prof Gilman), Universidad Peruana Cayetano Heredia, Lima, Peru; Program in Global Disease Epidemiology and Control (Prof Gilman and Dr Checkley), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Cardiovascular Imaging and Clinical Research Core Laboratory (Prof Dávila-Román), Cardiovascular Division, School of Medicine, Washington University in St. Louis, St. Louis, MO; and Departamento de Ciencias Biológicas y Fisiológicas (Prof León-Velarde and Drs Rivera-Ch and Huicho), Laboratorio de Adaptación a la Altura, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.

CORRESPONDENCE TO: William Checkley, MD, PhD, Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans St, Ste 9121, Baltimore, MD 21205; e-mail: wcheckl1@jhmi.edu


FUNDING/SUPPORT: This work was supported in part by the Center for Global Health of Johns Hopkins University and by federal funds of the National Heart, Lung, And Blood Institute, National Institutes of Health, Department of Health and Human Services [under Contract No. HHSN268200900033C], and by the International Clinical Research Scholars and Fellows Program, Fogarty International Center and National Heart, Blood, and Lung Institute, National Institutes of Health [R24TW007988]. Dr Checkley was further supported by a Pathway to Independence Award [R00HL096955] from the National Heart, Lung and Blood Institute, National Institutes of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1327-1336. doi:10.1378/chest.14-0298
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BACKGROUND:  Excessive erythrocytosis (EE) is a prevalent condition in populations living at high altitudes (> 2,500 m above sea level). Few large population-based studies have explored the association between EE and multiple subject-specific traits including oxygen saturation, iron status indicators, and pulmonary function.

METHODS:  We enrolled a sex-stratified and age-stratified sample of 1,065 high-altitude residents aged ≥ 35 years from Puno, Peru (3,825 m above sea level) and conducted a standardized questionnaire and physical examination that included spirometry, pulse oximetry, and a blood sample for multiple clinical markers. Our primary objectives were to estimate the prevalence of EE, characterize the clinical profile and iron status indicators of subjects with EE, and describe subject-specific traits associated with EE.

RESULTS:  Overall prevalence of EE was 4.5% (95% CI, 3.3%-6.0%). Oxygen saturation was significantly lower among EE than non-EE group subjects (85.3% vs 90.1%, P < .001) but no difference was found in iron status indicators between both groups (P > .09 for all values). In multivariable logistic regression, we found that age ≥ 65 years (OR = 2.45, 95% CI, 1.16-5.09), male sex (3.86, 1.78-9.08), having metabolic syndrome (2.66, 1.27-5.75) or being overweight (5.20, 1.95-16.77), pulse oximetry < 85% (14.90, 6.43-34.90), and % predicted FVC < 80% (13.62, 4.40-41.80) were strongly associated with EE. Attributable fractions for EE were greatest for being overweight (26.7%), followed by male sex (21.5%), pulse oximetry < 85% (16.4%), having metabolic syndrome (14.4%), and % predicted FVC < 80% (9.3%).

CONCLUSIONS:  We found a lower prevalence of EE than in previous reports in the Peruvian Andes. Although the presence of hypoxemia and decreased vital capacity were strongly associated with excessive erythrocytosis, being overweight or having metabolic syndrome were associated with an important fraction of cases in our study population.

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