Journal Article Ahead of print
PubMed: 41871447 DOI: 10.1093/annalsats/aaoag071
Age, sex, smoking-specific prevalence and progression in interstitial lung abnormality: patient-level meta-analysis.
Ann Am Thorac Soc
Authors: Kum Ju Chae, Hyunsook Hong, Claire C Cutting, Rachel K Putman, Anna J Podolanczuk, R Graham Barr, Jong Eun Lee, Yeon Joo Jeong, Soyeoun Lim, Gong Yong Jin, John A Mackintosh, Conal Hayton, Haval Balata, Nicola Sverzellati, Ugo Pastorino, Moisés Selman, Ivette Buendia-Roldan, Avignat S Patel, Peter M George, Richard J Hewitt, Anand Devaraj, Emily C Bartlett, Kerri Johannson, Alain Tremblay, Hiroto Hatabu, Jin Mo Goo, David A Lynch, Gary M Hunninghake, Soon Ho Yoon
Affiliations
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States.
- Department of Medicine, Columbia University Medical Center, New York, NY, United States.
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea.
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia.
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine, Health University of Manchester, Manchester, UKand.
- North West Interstitial Lung Disease Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester, United Kingdom.
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Scientific Direction, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Italy.
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, United States.
- Tufts University School of Medicine, Boston, MA, United States.
- Interstitial Lung Disease Unit, Royal Brompton & Harefield Hospitals, London, United Kingdom.
- National Heart and Lung Institute, Imperial College London, United Kingdom.
- King's Centre for Lung Health, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
- Departments of Medicine and Community Health Sciences, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.
- Department of Medicine, Charbonneau Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada.
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
- Department of Radiology, National Jewish Health, Denver, CO, United States.
Abstract
RATIONALE
Interstitial lung abnormalities (ILA) are incidental CT findings that often represent early, subclinical interstitial lung disease. Their prevalence and progression rates vary widely across studies, emphasizing the need to understand the impact of age, sex, and smoking for better risk stratification and management.
OBJECTIVES
To evaluate the prevalence and progression rates of ILA by age, sex, and smoking intensity using individual patient-level data from global cohorts, and to analyze progression-free survival (PFS).
METHODS
Systematic searches in OVID-MEDLINE and Embase identified eligible original articles reporting ILA prevalence or progression, confirmed through radiologist-reviewed CT scans. Random-effects models were used to pool estimates stratified by age, sex, and smoking intensity. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Progression-free survival (PFS) probabilities were calculated using Kaplan-Meier analysis.
MEASUREMENTS AND MAIN RESULTS
Data from 14 studies comprising 31,739 individual subjects showed a pooled ILA prevalence of 5.6% (95% CI, 4.3-7.3%), increasing with age from 2.5% (<55 years) to 14.6% (≥80 years). Age was the most influential factor, and it was further amplified in males and heavy smokers. The overall pooled progression was 34%, with fibrotic ILAs exhibiting higher progression, and age did not affect progression. PFS was evaluated in 202 individuals with ILA, with estimated rates of 76% at 3 years and 55% at 5 years.
CONCLUSIONS
Age is the strongest determinant of ILA prevalence. ILAs show significant progression on imaging over time, and progression is mainly driven by fibrotic features rather than age once ILA is established. Given the higher prevalence in older adults, targeted screening in aging populations remains appropriate, while follow-up strategies should be guided by fibrotic burden rather than age.
MeSH
Lung, Respiratory Tract Diseases, Aging, Prevalence, Sex, Smoking