Emphysema at Baseline Low-Dose CT Lung Cancer Screening Predicts Death from Chronic Obstructive Pulmonary Disease and Cardiovascular Disease Up to 25 Years Later

Background The prognostic value of baseline visual emphysema scoring at low-dose CT (LDCT) in lung cancer screening cohorts is unknown. Purpose To determine whether a single visual emphysema score at LDCT is predictive of 25-year mortality from all causes, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD). Materials and Methods In this prospective cohort study, asymptomatic adults aged 40-85 years with a history of smoking underwent baseline LDCT screening for lung cancer between June 2000 and December 2008. Follow-up continued until death, loss to follow-up, or December 31, 2024. Emphysema was assessed at baseline LDCT and scored from 0 (none) to 3 (severe) by one of four experienced chest radiologists. Baseline smoking history and comorbidities were self-reported. Causes of death (International Classification of Diseases, 10th Revision) were obtained from the U.S. National Death Index, physicians, and family. Associations between emphysema and mortality were evaluated using adjusted Cox proportional hazards and adjusted Fine-Gray competing risks models. Results Among 9047 participants (4614 female; median age, 65 years [IQR, 61-69 years]; median pack-years of smoking, 43 [IQR, 28-64]), 2637 (29.1%) had emphysema (mild in 1908 [21.1%], moderate in 512 [5.7%], and severe in 217 [2.4%]). Median follow-up was 23.3 years. Emphysema was independently predictive of all-cause mortality (hazard ratio [HR], 1.29; 95% CI: 1.21, 1.38; <i>P</i> < .001), COPD mortality (HR, 3.29; 95% CI: 2.59, 4.18; <i>P</i> < .001), and CVD mortality (HR, 1.14; 95% CI: 1.01, 1.29; <i>P</i> = .04). A dose-response relationship was observed between emphysema severity and both all-cause and COPD mortality, but not CVD mortality. In the adjusted competing risk analysis, emphysema remained associated with COPD mortality (HR, 3.06; 95% CI: 2.40, 3.90; <i>P</i> < .001), but not CVD mortality (HR, 1.04; 95% CI: 0.91, 1.18; <i>P</i> = .59). Conclusion Baseline emphysema at LDCT in a prospective lung cancer screening cohort of asymptomatic adults was predictive of all-cause, COPD, and CVD mortality up to 25 years later. © RSNA, 2025 <i>Supplemental material is available for this article.</i> See also the editorial by Mascalchi and Diciotti in this issue.

Authors

Institutions

Publication Details

Journal
Radiology
Published
2025-09-01
DOI
https://doi.org/10.1148/radiol.250949
Citations
5
Primary Topic
Chronic Obstructive Pulmonary Disease (COPD) Research
Type
article
Field-Weighted Citation Impact
7.59

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Emphysema at Baseline Low-Dose CT Lung Cancer Screening Predicts Death from Chronic Obstructive Pulmonary Disease and Cardiovascular Disease Up to 25 Years Later

Cynthia Chin, Donald Klippenstein, Artit Jirapatnakul, Mary Salvatore et al.
5 citations
Radiology
Chronic Obstructive Pulmonary Disease (COPD) Research
7.59
article

Emphysema at Baseline Low-Dose CT Lung Cancer Screening Predicts Death from Chronic Obstructive Pulmonary Disease and Cardiovascular Disease Up to 25 Years Later

Cynthia Chin, Donald Klippenstein, Artit Jirapatnakul, Mary Salvatore, Luis M. Montuenga, Gregory D. Pearson, Melissa Lim, Dan W. Luedke, Diana Yeh, Steven Markowitz, Michelle S. Ginsberg, Salvatore Giunta, David Mullen, Peter Loud, Robert Glassberg, Samuel M. Aguayo, Jeremy Green, Stefano Canitano, Davood Vafai, David P. Naidich, Ralph W. Aye, Michaela Straznicka, Meera Kondapaneni, William Mayfield, Mark A. Yoder, Xueguo Liu, Louis DeCunzo, David F. Yankelevitz, Nestor Villamizar, Elmer Camacho, Rowena Yip, Michael Kalafer, Timothy J. Harkin, Nasser K. Altorki, Enser Cole, Mark Widmann, James Walsh, Emanuela Taioli, Ernest M. Scalzetti, Thomas Bauer, Samuel Kopel, Javier J. Zulueta, Patrick Meyers, Barry Sheppard, Albert Koch, David Bertsch, Leslie J. Kohman, Andrew Brown, Georgeann McGuinness, Todd S. Weiser, Raja M. Flores, Anthony P. Reeves, Cliff P. Connery, Arnold Rotter, Paul Scheinberg, M. Kristin Thorsen, Richard J. Thurer, Demetris Patsios, Fred Grannis, Carmine Frumiento, Palmi Shah, José Cervera Deval, G Cecchi, Daniel Nicastri, Dorith Shaham, Othmar Schöb, Daniel M. Libby, David Gordon, Luis Seijo, Maurizio Infante, Takaomi Hanaoka, J. Lowry, Jessica González, Peter H. Wiernik, Alan Litwin, Andrea Wolf, Gary Herzog, Harvey I. Pass, M. Scopetuolo, Giula Veronesi, Ning Wu, James C. Willey, Laura S. Welch, Anthony Vacca, Michael V. Smith, James P. Smith, James P. O’Brien, Rakesh Shah, Albert Miller, Jana Taylor, Matthew D. Rifkin, Arfa Khan, Dennis Slater, Gorka Bastarika, Richard M. Hansen, Daniel Ray, Shahriyour Andaz, Andrew Kaufman, Mark Pasmantier, Edson H. Cheung, Cheryl Aylesworth, Carmen Endress, Robert J. Korst, Karl Klingler, David F. Yankelevitz, Shari-Lynn Odzer, Seth A. Cohen, David K. Olsen, Terence A.S. Matalon, Heidi Roberts, John H. M. Austin, Shusuke Sone
article en
5 citations

Abstract

Background The prognostic value of baseline visual emphysema scoring at low-dose CT (LDCT) in lung cancer screening cohorts is unknown. Purpose To determine whether a single visual emphysema score at LDCT is predictive of 25-year mortality from all causes, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD). Materials and Methods In this prospective cohort study, asymptomatic adults aged 40-85 years with a history of smoking underwent baseline LDCT screening for lung cancer between June 2000 and December 2008. Follow-up continued until death, loss to follow-up, or December 31, 2024. Emphysema was assessed at baseline LDCT and scored from 0 (none) to 3 (severe) by one of four experienced chest radiologists. Baseline smoking history and comorbidities were self-reported. Causes of death (International Classification of Diseases, 10th Revision) were obtained from the U.S. National Death Index, physicians, and family. Associations between emphysema and mortality were evaluated using adjusted Cox proportional hazards and adjusted Fine-Gray competing risks models. Results Among 9047 participants (4614 female; median age, 65 years [IQR, 61-69 years]; median pack-years of smoking, 43 [IQR, 28-64]), 2637 (29.1%) had emphysema (mild in 1908 [21.1%], moderate in 512 [5.7%], and severe in 217 [2.4%]). Median follow-up was 23.3 years. Emphysema was independently predictive of all-cause mortality (hazard ratio [HR], 1.29; 95% CI: 1.21, 1.38; <i>P</i> < .001), COPD mortality (HR, 3.29; 95% CI: 2.59, 4.18; <i>P</i> < .001), and CVD mortality (HR, 1.14; 95% CI: 1.01, 1.29; <i>P</i> = .04). A dose-response relationship was observed between emphysema severity and both all-cause and COPD mortality, but not CVD mortality. In the adjusted competing risk analysis, emphysema remained associated with COPD mortality (HR, 3.06; 95% CI: 2.40, 3.90; <i>P</i> < .001), but not CVD mortality (HR, 1.04; 95% CI: 0.91, 1.18; <i>P</i> = .59). Conclusion Baseline emphysema at LDCT in a prospective lung cancer screening cohort of asymptomatic adults was predictive of all-cause, COPD, and CVD mortality up to 25 years later. © RSNA, 2025 <i>Supplemental material is available for this article.</i> See also the editorial by Mascalchi and Diciotti in this issue.

RadiologyVol. 316(3)
Mount Sinai Hospital (US), Cornell University (US), Instituto de Salud Carlos III (ES), Hospital Universitari Arnau de Vilanova (ES), Mount Sinai Hospital (US), Phoenix VA Health Care System (US), Icahn School of Medicine at Mount Sinai (US)
U.S. Department of Energy, New York City Department of Health and Mental Hygiene, New York State Foundation for Science, Technology and Innovation, Rogers Family Foundation, National Institutes of Health, Weill Cornell Medical College, Instituto de Salud Carlos III
Openalex Percentile: Top 2%
Chronic Obstructive Pulmonary Disease (COPD) Research
7.59
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.