Results from PHRI’s PURE study have been published in two articles this spring in THE LANCET Global Health Journal – looking at the association between the extent of forced expiratory volume in 1 second (FEV1) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations; and at the association between socioeconomic status and differences in risk factors for cardiovascular disease incidence and outcomes.
The PURE study team, with MyLinh Duong as first author, published the article, Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community-based cohort study, in THE LANCET Global Health journal in May 2019.
The article notes that “there is little data on whether mild abnormalities in lung function, within clinically normal range, are associated with similar increases in poor health outcomes. Furthermore, most evidence is from western populations in high-income countries, whereas less data and knowledge are available regarding these associations in middle-income and low-income countries, where the scope of risk exposures, population susceptibility, and aetiological factors for lung function impairment are different.”
In the prospective cohort study, PURE, involving 126,359 adults from 628 urban and rural communities across 17 high-income, middle-income, and low-income countries, the PHRI-led team of researchers observed significant and graded increases in rates and risks of mortality, cardiovascular disease events, and respiratory hospitalizations with decreasing FEV1 values standardized by country-specific values (FEV1%).
The paper concludes “we showed a significant and graded relationship between lower baseline country-standardized FEV1% and future risk of mortality and cardio-respiratory morbidity. Addressing mild reductions in lung function could have a substantial effect on the population burden of cardio-respiratory diseases, particularly in high-risk groups such as tobacco users, people with known cardiovascular disease, and those living in poorly resourced settings. Further studies are also needed to examine how routine lung function measurement can help to better inform on the overall risk for poor general health outcomes.”
In the April 2019 article, “Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study,” The authors include Dr Annika Rosengren, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Sweden (first author), and several investigators at PHRI – Philip Joseph, Koon Teo, Salim Yusuf, PHRI’s director of statistics, Shrikant Bangdiwala, PHRI’s program director of global health (including PURE), Sumathy Rangarajan, and other international collaborators.
The article finds that “although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education.”
The large-scale prospective cohort study analyzed the health data of 154 ,169 adults 35 -70 years old, from 367 urban and 302 rural communities in 20 countries. Differences in outcomes between educational groups were not explained by differences in risk factors, which decreased as the level of education increased in high-income countries, but increased as the level of education increased in low-income countries