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Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study

BMJ 1996; 313 doi: (Published 21 September 1996) Cite this as: BMJ 1996;313:711
  1. D J Hole, principal epidemiologista,
  2. G C M Watt, professorb,
  3. G Davey-Smith, professorc,
  4. C L Hart, senior statisticiana,
  5. C R Gillis, directora,
  6. V M Hawthorne, professord
  1. a West of Scotland Cancer Surveillance Unit, Ruchill Hospital, Glasgow G20 9NB,
  2. b Department of General Practice, University of Glasgow, Glasgow,
  3. c Department of Social Medicine, University of Bristol, Bristol,
  4. d Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to: Dr Hole.
  • Accepted 26 June 1996


Objective: To assess the relation between forced expiratory volume in one second (FEV1) and subsequent mortality.

Design: Prospective general population study.

Setting: Renfrew and Paisley, Scotland.

Subjects: 7058 men and 8353 women aged 45-64 years at baseline screening in 1972-6.

Main outcome measure: Mortality from all causes, ischaemic heart disease, cancer, lung and other cancers, stroke, respiratory disease, and other causes of death after 15 years of follow up.

Results: 2545 men and 1894 women died during the follow up period. Significant trends of increasing risk with diminishing FEV1 are apparent for both sexes for all the causes of death examined after adjustment for age, cigarette smoking, diastolic blood pressure, cholesterol concentration, body mass index, and social class. The relative hazard ratios for all cause mortality for subjects in the lowest fifth of the FEV1 distribution were 1.92 (95% confidence interval 1.68 to 2.20) for men and 1.89 (1.63 to 2.20) for women. Corresponding relative hazard ratios were 1.56 (1.26 to 1.92) and 1.88 (1.44 to 2.47) for ischaemic heart disease, 2.53 (1.69 to 3.79) and 4.37 (1.84 to 10.42) for lung cancer, and 1.66 (1.07 to 2.59) and 1.65 (1.09 to 2.49) for stroke. Reduced FEV1 was also associated with an increased risk for each cause of death examined except cancer for lifelong nonsmokers.

Conclusions: Impaired lung function is a major clinical indicator of mortality risk in men and women for a wide range of diseases. The use of FEV1 as part of any health assessment of middle aged patients should be considered. Smokers with reduced FEV1 should form a priority group for targeted advice to stop smoking.

Key messages

  • These increased risks, with the exception of the cancers, are apparent for lifelong non-smokers

  • FEV1 is second in importance to cigarette smoking as a predictor of subsequent all cause mortality and is as important as cholesterol in predicting mortality from ischaemic heart disease

  • FEV1 should be included in health assessment of middle aged men and women

  • Smokers with a reduced FEV1 should be targeted with advice to stop smoking


  • Funding Clinical and Biomedical Research Committee, Chief Scientist Office, Scottish Office Home and Health Department (grant No K/MRS/50/C1750).

  • Conflict of interest None.

  • Accepted 26 June 1996
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