Association of life’s essential 8 with chronic respiratory disease mortality and lung health: a national cohort study

BACKGROUND: This study aims to evaluate the association of Life's Essential 8 (LE8) with chronic lower respiratory disease (CLRD)-specific mortality and impaired lung health outcomes. METHODS: This population-based cohort study used data from the National Health and Nutrition Examination Survey (NHANES, 2007-2018), including adults aged 20-79 years (n=10 135), with lung function measurements available for a subset (n=3188). Multivariable Cox proportional hazards and restricted cubic spline models were employed to assess the associations between LE8 scores and CLRD-specific mortality. Logistic and linear regression models evaluated the associations between LE8 scores and lung health. All models were adjusted for sociodemographic variables (age, sex, race/ethnicity, education, income-to-poverty ratio), cardiovascular disease, respiratory disease and smoking history. Sensitivity analyses were conducted to assess the stability of the results. The primary outcome was CLRD-specific mortality, and the secondary outcome was lung health. RESULTS: Over a median follow-up of 7.83 years, 50 CLRD-specific deaths were recorded. Higher LE8 scores were associated with reduced risks of CLRD-specific mortality (adjusted HR (aHR), 0.56 (0.40-0.79)), with a linear dose-response relationship observed (P for non-linear=0.574). Furthermore, each 10-point increase in total LE8 score was associated with impaired lung health, including lower odds of asthma (adjusted OR (aOR), 0.88 (0.83-0.93)), chronic bronchitis (aOR, 0.81 (0.74-0.88)), emphysema (aOR, 0.59 (0.52-0.65)), chronic obstructive pulmonary disease (aOR, 0.63 (0.45-0.89)) and lower relative risk of a restrictive spirometry pattern (adjusted relative risk ratio (aRRR), 0.66 (0.56-0.79)). Positive correlations were observed between total LE8 scores and lung function (p