• Anna J Podolanczuk, Elizabeth C Oelsner, R Graham Barr, Elana J Bernstein, Eric A Hoffman, Imaani J Easthausen, Karen Hinckley Stukovsky, Arindam RoyChoudhury, Erin D Michos, Ganesh Raghu, Steven M Kawut, and David J Lederer.
• 1 Department of Medicine.
• Am. J. Respir. Crit. Care Med. 2017 Dec 1; 196 (11): 143414421434-1442.

RationaleAreas of increased lung attenuation visualized by computed tomography are associated with all-cause mortality in the general population. It is uncertain whether this association is attributable to interstitial lung disease (ILD).ObjectivesTo determine whether high-attenuation areas are associated with the risk of ILD hospitalization and mortality in the general population.MethodsWe performed a cohort study of 6,808 adults aged 45-84 years sampled from six communities in the United States. High-attenuation areas were defined as the percentage of imaged lung volume with attenuation values between -600 and -250 Hounsfield units. An adjudication panel determined ILD hospitalization and death.Measurements And Main ResultsAfter adjudication, 52 participants had a diagnosis of ILD during 75,232 person-years (median, 12.2 yr) of follow-up. There were 48 hospitalizations attributable to ILD (crude rate, 6.4 per 10,000 person-years). Twenty participants died as a result of ILD (crude rate, 2.7 per 10,000 person-years). High-attenuation areas were associated with an increased rate of ILD hospitalization (adjusted hazard ratio, 2.6 per 1-SD increment in high-attenuation areas; 95% confidence interval, 1.9-3.5; P < 0.001), a finding that was stronger among men, African Americans, and Hispanics. High-attenuation areas were also associated with an increased rate of ILD-specific death (adjusted hazard ratio, 2.3; 95% confidence interval, 1.7-3.0; P < 0.001). Our findings were consistent among both smokers and nonsmokers.ConclusionsAreas of increased lung attenuation are a novel risk factor for ILD hospitalization and mortality. Measurement of high-attenuation areas by screening and diagnostic computed tomography may be warranted in at-risk adults.

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