{
  "abstract": "Background: Low peak expiratory flow (PEF) may precede the first self-report of recognized lung disease, but cross-cohort consistency and incremental value are uncertain. Methods: We analysed Health and Retirement Study (HRS) discovery and prespecified person-disjoint replication samples and the English Longitudinal Study of Ageing (ELSA). The estimand linked baseline PEF to the first subsequently observed self-report of recognized lung disease, not biological onset. HRS used a prespecified nominal lower-decile z score and ELSA an empirical lower decile. Participant-clustered models adjusted for demographic, clinical and functional factors. Weighting and a stroke comparator were sensitivity analyses. Post-hoc ELSA benchmarking compared PEF with FEV1 and FVC using person-disjoint cross-validation and full-pipeline bootstrap sensitivity. Results: Models included 18,510 HRS discovery windows (320 reports), 11,424 replication windows (188), and 8,634 ELSA person-waves (95). Low PEF was associated with first report in discovery (odds ratio [OR] 3.36, 95% confidence interval [CI] 2.54–4.45), replication (3.14, 2.19–4.49), and ELSA (3.77, 2.36–6.01). Weighted estimates were similar; stroke associations were weaker or null. After adjustment for separate FEV1 and FVC indices, the continuous-PEF OR was 1.04 (0.90–1.20). In 1,584 fixed-horizon participants (95 events), AUCs were 0.650 for covariates, 0.684 with PEF, 0.745 with FEV1 and FVC, and 0.739 with all three. Full-pipeline bootstrap sensitivity found no clear incremental evidence beyond FEV1 and FVC. Across differing horizons, low-PEF rules identified fewer than one-third of reports in HRS replication and ELSA. Conclusions: Lower PEF was associated with a subsequent first observed lung-disease report; cohort-specific low-PEF rules identified fewer than one-third. In exploratory fixed out-of-fold predictions, PEF improved average precision and prediction error over covariates; no clear incremental evidence remained after FEV1 and FVC. Same-protocol collection does not establish a peak-flow-only pathway.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Surgery, Suining Central Hospital, Suining, Sichuan, China",
    "Institute of Surgery, Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
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        0
      ],
      "name": "Haiyang Hu"
    },
    {
      "affs": [
        1
      ],
      "name": "Chun Wang"
    },
    {
      "name": "Jiang Fu"
    },
    {
      "name": "Haining Zhou"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/638c7g9mhg9ak.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0360668",
  "fulltext_url": null,
  "id": "638c7g9mhg9ak",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0360668",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Chronic Obstructive Pulmonary Disease (COPD) Research"
    ],
    [
      "plos",
      "/Biology and life sciences/Physiology/Physiological parameters/Body weight"
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  "pdf_url": "https://hrs.isr.umich.edu/sites/default/files/biblio/dr-011.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-12",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/638c7g9mhg9ak.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:30Z",
      "native_id": "10.1371/journal.pone.0360668",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0360668"
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      "subfield": "epidemiology-public-health"
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    {
      "field": "medicine",
      "origin": "plos:physiology",
      "subfield": "physiology"
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  "title": "Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA",
  "title_text": "Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:30Z",
  "url": "https://research.draconitic.com/paper/638c7g9mhg9ak",
  "venue": "PLOS One",
  "versions": []
}