TY - JOUR VL - 12 SP - e1498 A1 - Siddharthan, Trishul A1 - Grealis, Kyle A1 - Robertson, Nicole M A1 - Lu, Min A1 - Liu, Sibei A1 - Pollard, Suzanne L A1 - Hossen, Shakir A1 - Jackson, Peter A1 - Rykiel, Natalie A A1 - Wosu, Adaeze C A1 - Flores-Flores, Oscar A1 - Quaderi, Shumonta A A1 - Alupo, Patricia A1 - Kirenga, Bruce A1 - Ricciardi, Federico A1 - Barber, Julie A A1 - Chandyo, Ram K A1 - Sharma, Arun K A1 - Das, Santa Kumar A1 - Shresthra, Laxman A1 - Miranda, J Jaime A1 - Checkley, William A1 - Hurst, John R A1 - GECo Study, Investigators JF - The Lancet Global Health PB - Elsevier BV Y1 - 2024/09// N2 - BACKGROUND: More than 90% of the morbidity and mortality from chronic respiratory disease occurs in low-income and middle-income countries (LMICs), with substantial economic impact. Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with increased mortality in high-income countries. We aimed to conduct a post-hoc analysis of a cross-sectional study to assess the prevalence of, the risk factors for, and the impact of PRISm in three diverse LMIC settings. METHODS: We recruited a random, age-stratified and sex-stratified sample of the population in semi-urban Bhaktapur, Nepal; urban Lima, Peru; and rural Nakaseke, Uganda. Quality-assured post-bronchodilator spirometry was performed to American Thoracic Society standards and PRISm was defined as a forced expiratory volume in one second (FEV1) of less than 80% predicted with a FEV1/forced vital capacity ratio of 0·70 or more. We used t tests and ?2 analyses to assess the relationships between demographic, biometric, and comorbidity variables with PRISm. Multivariable logistic models with random intercept by site were used to estimate odds ratios (ORs) with 95% CIs. FINDINGS: 10?664 participants were included in the analysis, with a mean (SD) age of 56·3 (11·7) years and an equal distribution by sex. The prevalence of PRISm was 2·5% in Peru, 9·1% in Nepal, and 16·0% in Uganda. In multivariable analysis, younger age (OR for each decile of age 0·87, 95% CI 0·82-0·92) and being female (1·37, 1·18-1·58) were associated with increased odds of having PRISm. Biomass exposure was not consistently associated with PRISm across sites. Individuals with PRISm had impairment in respiratory-related quality of life as measured by the St George's Respiratory Questionnaire (OR by decile 1·18, 95% CI 1·10-1·25). INTERPRETATION: The prevalence of PRISm is heterogeneous across LMIC settings and associated with age, female sex, and biomass exposure, a common exposure in LMICs. A diagnosis of PRISm was associated with worse health status when compared with those with normal lung function. Health systems in LMICs should focus on all spirometric abnormalities as opposed to obstruction alone, given the disease burden, reduced quality of life, and size of the undiagnosed population at risk. FUNDING: Medical Research Council. ID - discovery10196067 UR - http://dx.doi.org/10.1016/s2214-109x(24)00233-x N1 - © 2024 The Author(s). Published by Elsevier Ltd. under a Creative Commons license (http://creativecommons.org/licenses/by/4.0/). KW - Humans KW - Cross-Sectional Studies KW - Spirometry KW - Female KW - Male KW - Prevalence KW - Adult KW - Middle Aged KW - Developing Countries KW - Peru KW - Nepal KW - Uganda KW - Forced Expiratory Volume KW - Aged KW - Risk Factors KW - Young Adult TI - Assessing the prevalence and impact of preserved ratio impaired spirometry in low-income and middle-income countries: a post-hoc cross-sectional analysis AV - public IS - 9 EP - e1505 ER -