Pulmonology (Dec 2025)
Geographical variation in lung function: Results from the multicentric cross-sectional BOLD study
- Peter G.J. Burney,
- James Potts,
- Ben Knox-Brown,
- Gregory Erhabor,
- Hamid Hacene Cherkaski,
- Kevin Mortimer,
- Mahesh Padukudru Anand,
- David M Mannino,
- Joao Cardoso,
- Rana Ahmed,
- Asma Elsony,
- Cristina Barbara,
- Rune Nielsen,
- Eric Bateman,
- Stefanni Nonna M Paraguas,
- Li Cher Loh,
- Abdul Rashid,
- Emiel FM Wouters,
- Frits ME Franssen,
- Hermínia Brites Dias,
- Thorarinn Gislason,
- Mohammed Al Ghobain,
- Mohammed El Biaze,
- Dhiraj Agarwal,
- Sanjay Juvekar,
- Fatima Rodrigues,
- Daniel O Obaseki,
- Parvaiz A. Koul,
- Imed Harrabi,
- Asaad A Nafees,
- Terence Seemungal,
- Christer Janson,
- William M Vollmer,
- Andre FS Amaral,
- A Sonia Buist
Affiliations
- Peter G.J. Burney
- National Heart and Lung Institute, Imperial College London, London, UK
- James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
- Gregory Erhabor
- Department of Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Osun, Nigeria
- Hamid Hacene Cherkaski
- Department of Pulmonology, Faculty of Medicine, University Badji Mokhtar, Annaba, Algeria
- Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK
- Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysuru, India
- David M Mannino
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY, USA
- Joao Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- Rana Ahmed
- The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
- Asma Elsony
- The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
- Cristina Barbara
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Eric Bateman
- Department of Medicine, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- Stefanni Nonna M Paraguas
- Philippine College of Chest Physicians, Manila, Philippines
- Li Cher Loh
- Department of Public Health, Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Penang, Malaysia
- Abdul Rashid
- Department of Public Health, Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Penang, Malaysia
- Emiel FM Wouters
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- Frits ME Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Hermínia Brites Dias
- Lisbon School of Health Technology, Polytechnic of Lisbon, Lisbon, Portugal
- Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Mohammed Al Ghobain
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Mohammed El Biaze
- Department of Respiratory Medicine, Faculty of Medicine, Mohammed Ben Abdellah University, Fes, Morocco
- Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- Fatima Rodrigues
- Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Daniel O Obaseki
- Department of Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Osun, Nigeria
- Parvaiz A. Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
- Imed Harrabi
- Ibn El Jazzar Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Asaad A Nafees
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
- Terence Seemungal
- Department of Clinical Medical Sciences, The University of The West Indies, St Augustine, Trinidad and Tobago
- Christer Janson
- Department of Medical Sciences, Respiratory Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- William M Vollmer
- Center for Health Research, Kaiser Permanente Center for Health Research, Portland, OR, USA
- Andre FS Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
- A Sonia Buist
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
- DOI
- https://doi.org/10.1080/25310429.2024.2430491
- Journal volume & issue
-
Vol. 31,
no. 1
Abstract
Spirometry is used to determine what is “unusual” lung function compared with what is “usual” for healthy non-smokers. This study aimed to investigate regional variation in the forced vital capacity (FVC) and in the forced expiratory volume in one second to FVC ratio (FEV1/FVC) using cross-sectional data from all 41 sites of the multinational Burden of Obstructive Lung Disease study. Participants (5,368 men; 9,649 women), aged ≥40 years, had performed spirometry, had never smoked and reported no respiratory symptoms or diagnoses. To identify regions with similar FVC, we conducted a principal component analysis (PCA) on FVC with age, age2 and height2, separately for men and women. We regressed FVC against age, age2 and height2, and FEV1/FVC against age and height2, for each sex and site, stratified by region. Mean age was 54 years (both sexes), and mean height was 1.69 m (men) and 1.61 m (women). The PCA suggested four regions: 1) Europe and richer countries; 2) the Near East; 3) Africa; and 4) the Far East. For the FVC, there was little variation in the coefficients for age, or age2, but considerable variation in the constant (men: 2.97 L in the Far East to 4.08 L in Europe; women: 2.44 L in the Far East to 3.24 L in Europe) and the coefficient for height2. Regional differences in the constant and coefficients for FEV1/FVC were minimal (<1%). The relation of FVC with age, sex and height varies across and within regions. The same is not true for the FEV1/FVC ratio.
Keywords
- Cross-sectional studies
- global health
- forced expiratory volume
- forced vital capacity
- airflow obstruction
