Global Initiative on Obstructive Lung Disease (GOLD) classification of lung disease and mortality: Findings from the Atherosclerosis Risk in Communities (ARIC) study

David M. Mannino, Dennis E. Doherty, A. Sonia Buist

Research output: Contribution to journalArticle

232 Scopus citations


Objective: To determine whether a modified Global Initiative on Obstructive Lung Diseases (GOLD) classification of chronic obstructive pulmonary disease (COPD) predicts mortality in a cohort of subjects followed for up to 11 years. Methods: We analyzed data from 15,759 adult participants, aged 43-66 years at baseline, in the Atherosclerosis Risk in Communities (ARIC) study. All baseline and follow-up data were available for 15,440 (97.9%) of the initial participants. We classified subjects using a modification of the GOLD criteria for COPD (prebronchodilator forced expiratory volume in 1 s (FEV1) stratification of disease severity), and added a "restricted" category (FEV1/FVC>70% and FVC<80% predicted). We used Cox proportional hazard models to determine the risk of impaired lung function on subsequent mortality, after adjusting for age, race, sex and smoking status. Results: 1242 (8.0%) subjects died by the end of 1997. The overall rate of death was 8.9 per 1000 person years, but varied from 5.4/1000 among normal subjects to 42.9/1000 among subjects with GOLD Stage 3 or 4 COPD. After adjusting for covariates, all GOLD categories, along with the restricted category, predicted a higher risk of death: GOLD Stage 3 or 4, hazard ratio (HR) 5.7, 95% confidence interval (CI) 4.4, 7.3; GOLD Stage 2 HR 2.4, 95% CI 2.0, 2.9; GOLD Stage 1 HR 1.4, 95% CI 1.1, 1.6; GOLD Stage 0 HR 1.5, 95% CI 1.3, 1.8; and restricted HR 2.3, 95% CI 1.9, 2.8. Conclusion: The modified GOLD classification system of COPD predicts mortality in this cohort of middle-aged Americans followed for up to 11 years.

Original languageEnglish (US)
Pages (from-to)115-122
Number of pages8
JournalRespiratory Medicine
Issue number1
StatePublished - Jan 1 2006



  • COPD
  • Cohort study
  • GOLD classification
  • Lung function
  • Mortality
  • Smoking

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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