Low levels of emphysema burden on LDCT and spirometry-based OLD: Joint Effects on Mortality.

Authors

Danbee Kang, Yoosoo Chang, You Jin Oh, Jung Hye Hwang, Sun Hye Shin, Seungho Ryu, Ho Yun Lee, Hye Yun Park

Published in

Chest. Jul 28, 2026. Epub Jul 28, 2026.

Abstract

Theprognostic value of low levels of CT-defined emphysema and their interaction with obstructive lung disease (OLD) remains unclear.
Does emphysema, as defined by low-attenuation areas (LAA-₉₅₀) on CT, confer differential mortality risk according to the presence of airflow limitation?
We included 5,276 adults who underwent low-dose CT and spirometry between 2010 and 2019. Mortality was ascertained through linkage with national death records. Cox models estimated hazard ratios (HRs) for mortality according to LAA-₉₅₀ and OLD. Dose-response relationships were assessed using restricted cubic splines, and progression was evaluated among participants with low baseline emphysema.
Among 5,276 adults in a health-screening cohort, 66.3% were men and 47.2% were ever smokers. Over a median follow-up of 12.9 years, LAA-950 ≥1.5% alone (HR 1.32, 95% CI 0.85 to 2.06) and OLD alone (HR 0.95, 95% CI 0.50 to 1.80) were not associated with mortality. Their combination increased risk (HR 3.10, 95% CI 1.77 to 5.42; p for interaction = 0.04). A graded association between emphysema and mortality was observed only in individuals with OLD. In stratified analyses, emphysema was associated with mortality in never smokers without OLD, whereas a joint effect was observed in ever smokers. Among participants with LAA-950 <1.5%, progression to ≥1.5% increased mortality in those with OLD (HR 3.97, 95% CI 1.23 to 12.90), but not in those without OLD.
Low-level CT-defined emphysema was associated with higher all-cause mortality mainly when accompanied by spirometry-defined OLD. These findings suggest that low-level LAA-₉₅₀ may have greater prognostic relevance in the presence of airflow limitation.

PMID:
42521149
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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