{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:22:05Z","timestamp":1769156525250,"version":"3.49.0"},"reference-count":20,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[1989,6]]},"abstract":"<jats:p>Fifteen year chronic bronchitis mortality was investigated among 17,717 male civil servants aged 40-64 years participating in the Whitehall Study. Associations were assessed between mortality and Medical Research Council standardised questions about chronic phlegm production and breathlessness, and a measure of lung function. Low FEV1 was the most powerful single predictor of mortality; controlling for age, smoking habits and employment grade, the relative hazards ratio (RHR) was 20. Using mortality rates standardised for age and smoking, the proportion of mortality in the total population statistically attributable to low FEV1 (population excess fraction) was 57%. Breathlessness while walking on the level was the best predictor among the questions and combinations of questions; the relative hazards ratio was 12 and the population excess fraction, 39%. A Medical Research Council definition of chronic bronchitis including chronic phlegm production and breathlessness was also strongly associated with chronic bronchitis mortality (RHR = 13); however, the population excess fraction was only 20%. This definition identified only 30% of the 64 deaths, and added almost nothing to prediction by FEV1 alone. The results suggest that although the combination of chronic phlegm production and chronic airflow limitation is strongly associated with mortality from chronic bronchitis, the presence of chronic phlegm production alone is not associated with mortality.<\/jats:p>","DOI":"10.1136\/jech.43.2.168","type":"journal-article","created":{"date-parts":[[2008,11,12]],"date-time":"2008-11-12T15:10:54Z","timestamp":1226502654000},"page":"168-172","source":"Crossref","is-referenced-by-count":19,"title":["Predicting 15 year chronic bronchitis mortality in the Whitehall Study."],"prefix":"10.1136","volume":"43","author":[{"given":"K L","family":"Ebi-Kryston","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1989,6,1]]},"reference":[{"key":"ref_1","first-page":"775","article-title":"Definition and classification of chronic bronchitis for clinical and epidemiological purposes","volume":"i:","author":"l Medical Research Council","year":"1965","unstructured":"l Medical Research Council. Definition and classification of chronic bronchitis for clinical and epidemiological purposes. Lancet 1965; i: 775-9.","journal-title":"Lancet"},{"key":"ref_2","article-title":"Questionnaire on respiratory symptoms and instructions for its use","author":"Council, Medical Research","year":"1966","unstructured":"Medical Research Council. Questionnaire on respiratory symptoms and instructions for its use. London: Medical Research Council, 1966."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1136\/jech.32.4.282","article-title":"Terminology in chronic obstructive lung diseases","volume":"32","author":"Fletcher, C.M.","year":"1978","unstructured":"Fletcher CM. Terminology in chronic obstructive lung diseases. J Epidemiol Community Health 1978; 32: 282-8.","journal-title":"J Epidemiol Community Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1136\/thx.14.4.286","article-title":"Terminology, definitions and classifications of chronic pulmonary emphysema and related conditions","volume":"14","author":"Symposium, Ciba Foundation Guest","year":"1959","unstructured":"Ciba Foundation Guest Symposium. Terminology, definitions and classifications of chronic pulmonary emphysema and related conditions. Thorax 1959; 14: 286-99.","journal-title":"Thorax"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1080\/00039896.1970.10667260","article-title":"Predictors of mortality in the adult population of Tecumseh. Respiratory symptoms, chronic respiratory disease, and ventilatory lung function","volume":"21","author":"Higgins, M.W.; Keller, J.B.","year":"1970","unstructured":"Higgins MW, Keller JB. Predictors of mortality in the adult population of Tecumseh. Respiratory symptoms, chronic respiratory disease, and ventilatory lung function. Arch Environ Health 1970; 21: 418-24.","journal-title":"Arch Environ Health"},{"key":"ref_6","article-title":"Speizer FE: The natural history of chronic bronchitis and emphysema","author":"Fletcher, C.M.; Peto, R.; Tinker, C.M.","year":"1976","unstructured":"Fletcher CM, Peto R, Tinker CM, Speizer FE: The natural history of chronic bronchitis and emphysema. Oxford: Oxford University Press, 1976."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1136\/bmj.1.6077.1645","article-title":"The natural history of chronic airflow obstruction","volume":"i:","author":"Fletcher, C.M.; Peto, R.","year":"1977","unstructured":"Fletcher CM, Peto R. The natural history of chronic airflow obstruction. Br Med J 1977; i: 1645-8.","journal-title":"Br Med J"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/ije\/8.3.201","article-title":"Twelve years' spirometric changes among Paris area workers","volume":"8","author":"Kauffmann, F.; Drouet, D.; Lellouch, J.; Brille, D.","year":"1979","unstructured":"Kauffmann F, Drouet D, Lellouch J, Brille D. Twelve years' spirometric changes among Paris area workers. Int J Epidemiol 1979; 8: 201-12.","journal-title":"Int J Epidemiol"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1164\/arrd.1983.128.3.491","article-title":"The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years ofprospective observation","volume":"128","author":"Peto, R.; Speizer, F.E.; Cochrane, A.L.","year":"1983","unstructured":"Peto R, Speizer FE, Cochrane AL, et al. The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years ofprospective observation. Am Rev Respir Dis 1983; 128: 491-500.","journal-title":"Am Rev Respir Dis"},{"issue":"251 -60","key":"ref_10","article-title":"Respiratory symptoms and measurements as predictors of 10-year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall study","volume":"41","author":"Ebi-Kryston, K.L.","year":"1988","unstructured":"Ebi-Kryston KL. Respiratory symptoms and measurements as predictors of 10-year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall study. J Clin Epidemiol 1988; 41: 251 -60.","journal-title":"J Clin Epidemiol"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1136\/thx.39.2.81","article-title":"Definitions of emphysema, chronic bronchitis, asthma, and airflow obstruction: 25 years on from the Ciba symposium","volume":"39","author":"Fletcher, C.M.; Pride, N.B.","year":"1984","unstructured":"Fletcher CM, Pride NB. Definitions of emphysema, chronic bronchitis, asthma, and airflow obstruction: 25 years on from the Ciba symposium. Thorax 1984; 39: 81-85.","journal-title":"Thorax"},{"key":"ref_12","first-page":"469","article-title":"Cardiorespiratory disease and diabetes among middle-aged male civil servants. A study of screening and intervention","volume":"i:","author":"Reid, D.D.; Brett, G.Z.; Hamilton, P.J.S.; Jarrett, R.J.; Keen, H.; Rose, G.","year":"1974","unstructured":"Reid DD, Brett GZ, Hamilton PJS, Jarrett RJ, Keen H, Rose G. Cardiorespiratory disease and diabetes among middle-aged male civil servants. A study of screening and intervention. Lancet 1974; i: 469-73.","journal-title":"Lancet"},{"key":"ref_13","article-title":"Committee on the Aetiology of Chronic Bronchitis. Standardized questionnaires on respiratory symptoms","author":"Council, Kristie L Ebi-Kryston 13 Medical Research","year":"1960","unstructured":"Kristie L Ebi-Kryston 13 Medical Research Council, Committee on the Aetiology of Chronic Bronchitis. Standardized questionnaires on respiratory symptoms. Br Med J 1960; ii: 1665.","journal-title":"Br Med J"},{"key":"ref_14","first-page":"1007","article-title":"Observers' errors in taking medical histories","volume":"i:","author":"Cocrane, A.L.; Chapman, P.J.; Oldham, P.D.","year":"1951","unstructured":"Cocrane AL, Chapman PJ, Oldham PD. Observers' errors in taking medical histories. Lancet 1951; i: 1007-9.","journal-title":"Lancet"},{"key":"ref_15","article-title":"statistical software, 1983 printing with additions","author":"WJBMDP, Dixon","year":"1983","unstructured":"Dixon WJ, ed. BMDP statistical software, 1983 printing with additions. Berkeley: University of California Press, 1983."},{"key":"ref_16","volume-title":"A dictionary ofepidemiology","author":"Last, J.M.","year":"1983","unstructured":"Last JM, ed. A dictionary ofepidemiology. Oxford: Oxford University Press, 1983."},{"key":"ref_17","first-page":"206","article-title":"International trends in mortality rates for bronchitis, emphysema and asthma during the period 1971-1980","volume":"39","author":"Melia, R.J.W.; Swan, A.V.","year":"1986","unstructured":"Melia RJW, Swan AV. International trends in mortality rates for bronchitis, emphysema and asthma during the period 1971-1980. World Health Stat Q 1986; 39: 206-17.","journal-title":"World Health Stat Q"},{"key":"ref_18","first-page":"49","article-title":"Trends in cigarette smoking in the United Kingdom","volume":"10","author":"Capell, P.J.","year":"1978","unstructured":"Capell PJ. Trends in cigarette smoking in the United Kingdom. Health Trends 1978; 10: 49-54.","journal-title":"Health Trends"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1136\/jech.36.2.113","article-title":"Cigarettes, lung cancer, and coronary heart disease: the effects of inhalation and tar yield","volume":"36","author":"Higenbottam, T.; Shipley, M.J.; Rose, G.","year":"1982","unstructured":"Higenbottam T, Shipley MJ, Rose G. Cigarettes, lung cancer, and coronary heart disease: the effects of inhalation and tar yield. J Epidemiol Community Health 1982; 36: 113-7.","journal-title":"J Epidemiol Community Health"},{"key":"ref_20","article-title":"Acceptedfor publication","year":"1988","unstructured":"Acceptedfor publication November 1988"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech.43.2.168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T11:36:05Z","timestamp":1759836965000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech.43.2.168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,6]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1989,6,1]]},"published-print":{"date-parts":[[1989,6]]}},"alternative-id":["10.1136\/jech.43.2.168"],"URL":"https:\/\/doi.org\/10.1136\/jech.43.2.168","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[1989,6]]}}}