ArticlePloS one2026
Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLow peak expiratory flow (PEF) may precede the first self-report of recognized lung disease, but cross-cohort consistency and incremental value are uncertain.
methodsWe 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.
resultsModels 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.
conclusionsLower 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.
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