@article {Miele1120, author = {Catherine H Miele and Matthew R Grigsby and Trishul Siddharthan and Robert H Gilman and J Jaime Miranda and Antonio Bernabe-Ortiz and Robert A Wise and William Checkley}, editor = {, and , and Bernab{\'e}-ortiz, Antonio and Casas, Juan P and Smith, George Davey and Ebrahim, Shah and Garc{\'\i}a, H{\'e}ctor H and Gilman, Robert H and Huicho, Luis and M{\'a}laga, Germ{\'a}n and Miranda, J Jaime and Montori, V{\'\i}ctor M and Smeeth, Liam and Checkley, William and Diette, Gregory B and Gilman, Robert H and Huicho, Luis and Le{\'o}n-velarde, Fabiola and Rivera, Mar{\'\i}a and Wise, Robert A and Checkley, William and Garc{\'\i}a, H{\'e}ctor H and Gilman, Robert H and Miranda, J Jaime and Sacksteder, Katherine}, title = {Environmental exposures and systemic hypertension are risk factors for decline in lung function}, volume = {73}, number = {12}, pages = {1120--1127}, year = {2018}, doi = {10.1136/thoraxjnl-2017-210477}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Chronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries.Methods We collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged >=35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline.Results Mean{\textpm}SD enrolment age was 55.4{\textpm}12.5 years, 49.2\% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95\% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9\% (95\% CI 15.7\% to 36.1\%), 21.3\% (11.1\% to 31.5\%) and 15.7\% (3.7\% to 26.9\%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1\% (95\% CI\% 29.8\% to 54.4\%), 36.0\% (23.7\% to 48.2\%) and 15.8\% (2.6\% to 28.9\%) of the overall mean annual decline, respectively.Conclusion Urbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence.}, issn = {0040-6376}, URL = {https://thorax.bmj.com/content/73/12/1120}, eprint = {https://thorax.bmj.com/content/73/12/1120.full.pdf}, journal = {Thorax} }