Longitudinal versus cross-sectional estimates of lung function decline—further insights
ABSTRACT This paper explores the extent to which differences in longitudinal versus cross-sectional inference may be influenced by the choice of statistical models. Using lung function data on 524 working men, we first compare the goodness-of-fit and implication for longitudinal decline of a variety of cross-sectional models. We then compare the predicted longitudinal patterns from these models with those observed over a period of four years. In general, both approaches provide qualitatively, if not quantitatively, similar messages concerning the relative effects of smoking and age on lung function decline. Nonetheless, we acknowledge the existence of real selection and cohort effects. Although we recognize the utility of cross-sectional designs, we discourage quantitative comparisons between studies, especially longitudinal versus cross-sectional.
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- "As in the previous studies [1,2] the rate of decline of actual FEV1 is greater than that suggested by reference equations [12,17] which are derived from cross-sectional data. Values derived from longitudinal data may differ from cross-sectional observations for a number of reasons [18,19]. These include a cohort effect and, with lung function, loss of height with ageing which will mask decline in the cross sectional tables. "
ABSTRACT: The Darlington and Northallerton Asthma Study is an observational cohort study started in 1983. At that time little was published about long term outcome in asthma and the contribution of change in reversible disease or airway remodelling to any excess deterioration in function. The study design included regular review of overall and fixed function lung. We report the trends over fifteen years. All asthmatics attending secondary care in 1983, 1988 and 1993 were recruited. Pulmonary function was recorded at attendance and potential best function estimated according to protocol. Rate of decline was calculated over each 5-year period and by linear regression analysis in those seen every time. The influence of potential explanatory variables on this decline was explored. 1724 satisfactory 5-year measurements were obtained in 912 subjects and in 200 subjects on all occasions. Overall rate of decline (ml/year (95%CI)) calculated from 5-year periods was FEV1 male 41.0 (34.7-47.3), female 28.9 (23.2-34.6) and best FVC male 63.1 (55.1-71.2)ml/year, female 45.8 (40.0-51.6). The principal association was with age. A dominant cubic factor suggested fluctuations in the rate of change in middle life with less rapid decline in youth and more rapid decline in the elderly. Rapid decline was possibly associated with short duration. Treatment step did not predict rate of deterioration. Function declined non-linearly and more rapidly than predicted from normal subjects. It reports for the first time a cubic relationship between age and pulmonary function. This should be taken into account when interpreting other articles reporting change in function over time.BMC Pulmonary Medicine 02/2005; 5(1):2. DOI:10.1186/1471-2466-5-2 · 2.49 Impact Factor
- Annals of the New York Academy of Sciences 02/1991; 624:195-208. · 4.31 Impact Factor