{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T12:02:46Z","timestamp":1793880166171,"version":"4.7.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":253,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"NHLBI\u2013Collaborating Network of Networks for Evaluating COVID-19 and Therapeutic Strategies (CONNECTS)\/Researching COVID to Enhance Recovery","award":["OT2HL156812"],"award-info":[{"award-number":["OT2HL156812"]}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Increased risk of coronavirus disease (COVID-19) hospitalization and death has been reported among patients with clinical lung disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the association of objective measures of prepandemic lung function and structure with COVID-19 outcomes in U.S. adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prepandemic obstruction (FEV1\/FVC\u2009&amp;lt;\u20090.70) and restriction (FEV1\/FVC\u2009\u2a7e\u20090.7, FVC\u2009&amp;lt;\u200980%) were defined based on the most recent spirometry exam conducted in 11 prospective U.S. general population\u2013based cohorts. Severe obstruction was classified by FEV1\u2009&amp;lt;\u200950%. Percentage emphysema, percentage high-attenuation areas, and interstitial lung abnormalities were defined on computed tomography in a subset. Incident COVID-19 was ascertained via questionnaires, serosurvey, and medical records from 2020 to 2023 and classified as severe (hospitalized or fatal) or nonsevere. Cause-specific hazard models were adjusted for sociodemographics, anthropometry, smoking, comorbidities, and COVID-19 vaccination status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Among 29,323 participants (mean age, 67 yr), there were 748 severe incident COVID-19 cases over median follow-up of 17.3 months from March 1, 2020. Greater hazards of severe COVID-19 were associated with severe obstruction (vs. normal; adjusted hazard ratio [aHR],\u20092.11; 95% confidence interval [CI], 1.02\u20131.27), restriction (vs. normal; aHR,\u20091.40; 95% CI, 1.12\u20131.76), and percentage emphysema (highest vs. lowest quartile; aHR, 1.64; 95% CI, 1.03\u20132.61), but not greater high-attenuation areas or interstitial lung abnormalities. COVID-19 vaccination provided greater absolute risk reduction in these groups. Results were similar in participants without smoking, obesity, or clinical cardiopulmonary disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prepandemic severe spirometric obstruction, spirometric restriction, and greater percentage emphysema lung on computed tomography were associated with risk of severe COVID-19. These findings support enhanced COVID-19 risk mitigation for individuals with impaired lung health and warrant further mechanistic studies on interactions of lung function, structure, and vulnerability to acute respiratory illnesses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202408-1656oc","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T14:09:31Z","timestamp":1744812571000},"page":"1196-1210","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":4,"title":["Associations of Prepandemic Lung Function and Structure with COVID-19 Outcomes: The C4R Study"],"prefix":"10.1093","volume":"211","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5610-3744","authenticated-orcid":false,"given":"Pallavi P.","family":"Balte","sequence":"first","affiliation":[{"name":"Division of General Medicine, Department of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Mailman School of Public Health, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nori","family":"Allen","sequence":"additional","affiliation":[{"name":"Center for Epidemiology and Population Health, Northwestern Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa","family":"Angelini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Columbia University, New York, New York"},{"name":"Telecom Paris, Information Processing and Communications Laboratory, Institut Polytechnique de Paris, Palaiseau, France"},{"name":"National Institute for Health and Care Research Imperial Biomedical Research Centre, Institute for Translational Medicine and Therapeutics Data Science Group, Imperial College, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Arynchyn","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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