Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: findings from the Atherosclerosis Risk in Communities (ARIC) study

• Published in: Respiratory medicine Vol. 100; no. 1; pp. 115 - 122
• Main Authors: Mannino, David M., Doherty, Dennis E., Sonia Buist, A.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2006; Elsevier; Elsevier Limited
• Subjects: Adult; African Continental Ancestry Group; Aged; Americas - epidemiology; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Cohort study; COPD; European Continental Ancestry Group; Female; Forced Expiratory Volume; GOLD classification; Humans; Lung function; Male; Medical sciences; Middle Aged; Mortality; Pneumology; Prospective Studies; Pulmonary Disease, Chronic Obstructive - classification; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - mortality; Risk Factors; Severity of Illness Index; Smoking; Tobacco, tobacco smoking; Toxicology; Vital Capacity; Americas; Lung function; GOLD classification; Mortality; Cohort study; COPD; Smoking; Gold; Lung disease; Prognosis; Respiratory disease; Tobacco smoking; Cardiovascular disease; Risk; Epidemiology; Vascular disease; Chronic; Atherosclerosis; Classification; Risk factor; Bronchus disease; Obstructive pulmonary disease; Community
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2005.03.035

To determine whether a modified Global Initiative on Obstructive Lung Diseases (GOLD) classification of chronic obstructive pulmonary disease (COPD) predicts mortality 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 15,440 (97.9%) of the initial participants. We classified subjects using a modification of the GOLD criteria for COPD (prebronchodilator forced expiratory volume in 1 s (FEV 1) stratification of disease severity), and added a “restricted” category (FEV 1/FVC>70% and FVC<80% predicted). We used Cox proportional hazard models to determine the risk of impaired lung function on subsequent mortality, after adjusting for age, race, sex and smoking status. 1242 (8.0%) subjects died by the end of 1997. The overall rate of death was 8.9 per 1000 person years, but varied from 5.4/1000 among normal subjects to 42.9/1000 among subjects with GOLD Stage 3 or 4 COPD. After adjusting for covariates, all GOLD categories, along with the restricted category, predicted a higher risk of death: GOLD Stage 3 or 4, hazard ratio (HR) 5.7, 95% confidence interval (CI) 4.4, 7.3; GOLD Stage 2 HR 2.4, 95% CI 2.0, 2.9; GOLD Stage 1 HR 1.4, 95% CI 1.1, 1.6; GOLD Stage 0 HR 1.5, 95% CI 1.3, 1.8; and restricted HR 2.3, 95% CI 1.9, 2.8. The modified GOLD classification system of COPD predicts mortality in this cohort of middle-aged Americans followed for up to 11 years.