Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA
- 1Department of Thoracic Surgery, Suining Central Hospital, Suining, Sichuan, China
- 2Institute of Surgery, Graduate School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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.
Related
- Transitions Among Four Spirometric States and Subsequent Pre-Bronchodilator Airflow Obstruction: A Community Cohort Study.
- Quantitative CT features for COPD classification and GOLD spirometric severity assessment: a single-center model-development study
- Effect of intraoperative high positive end-expiratory pressure with recruitment manoeuvres versus low positive end-expiratory pressure on postoperative lung function in obese adults: a substudy of the protective ventilation in obese patients randomised controlled trial
- Right-left discordance of pulmonary artery wedge pressure under high positive end-expiratory pressure in acute eccentric mitral regurgitation
- Baseline peak expiratory flow and incident hip fracture in older Chinese adults : A prospective CHARLS cohort study
BibTeX
@article{hu2026peak,
title = {{Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA}},
author = {Haiyang Hu and Chun Wang and Jiang Fu and Haining Zhou},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360668},
url = {https://doi.org/10.1371/journal.pone.0360668},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA
AU - Haiyang Hu
AU - Chun Wang
AU - Jiang Fu
AU - Haining Zhou
PY - 2026
DA - 2026/10/12
JO - PLOS One
DO - 10.1371/journal.pone.0360668
UR - https://doi.org/10.1371/journal.pone.0360668
AB - 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.
SN - 1932-6203
ER -