{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:49:53Z","timestamp":1791827393851,"version":"4.3.4"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low peak expiratory flow (PEF) may precede the first self-report of recognized lung disease, but cross-cohort consistency and incremental value are uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed Health and Retirement Study (HRS) discovery and prespecified person-disjoint replication samples and the English Longitudinal Study of Ageing (ELSA). The estimand linked baseline PEF to the first subsequently observed self-report of recognized lung disease, not biological onset. HRS used a prespecified nominal lower-decile z score and ELSA an empirical lower decile. Participant-clustered models adjusted for demographic, clinical and functional factors. Weighting and a stroke comparator were sensitivity analyses. Post-hoc ELSA benchmarking compared PEF with FEV1 and FVC using person-disjoint cross-validation and full-pipeline bootstrap sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Models included 18,510 HRS discovery windows (320 reports), 11,424 replication windows (188), and 8,634 ELSA person-waves (95). Low PEF was associated with first report in discovery (odds ratio [OR] 3.36, 95% confidence interval [CI] 2.54\u20134.45), replication (3.14, 2.19\u20134.49), and ELSA (3.77, 2.36\u20136.01). Weighted estimates were similar; stroke associations were weaker or null. After adjustment for separate FEV1 and FVC indices, the continuous-PEF OR was 1.04 (0.90\u20131.20). In 1,584 fixed-horizon participants (95 events), AUCs were 0.650 for covariates, 0.684 with PEF, 0.745 with FEV1 and FVC, and 0.739 with all three. Full-pipeline bootstrap sensitivity found no clear incremental evidence beyond FEV1 and FVC. Across differing horizons, low-PEF rules identified fewer than one-third of reports in HRS replication and ELSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower PEF was associated with a subsequent first observed lung-disease report; cohort-specific low-PEF rules identified fewer than one-third. In exploratory fixed out-of-fold predictions, PEF improved average precision and prediction error over covariates; no clear incremental evidence remained after FEV1 and FVC. Same-protocol collection does not establish a peak-flow-only pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360668","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:22:21Z","timestamp":1791825741000},"page":"e0360668","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low peak expiratory flow and subsequent first self-report of recognized lung disease: Person-disjoint replication and spirometric benchmarking in HRS and ELSA"],"prefix":"10.1371","volume":"21","author":[{"given":"Haiyang","family":"Hu","sequence":"first","affiliation":[{"name":"Suining Central Hospital","place":["Suining, Sichuan, China"],"department":["Department of Thoracic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Wang","sequence":"additional","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine","place":["Chengdu, China"],"department":["Institute of Surgery, Graduate School"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Fu","sequence":"additional","affiliation":[{"name":"Suining Central Hospital","place":["Suining, Sichuan, China"],"department":["Department of Thoracic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-2809","authenticated-orcid":true,"given":"Haining","family":"Zhou","sequence":"additional","affiliation":[{"name":"Suining Central Hospital","place":["Suining, Sichuan, China"],"department":["Department of Thoracic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"3","key":"pone.0360668.ref001","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1378\/chest.106.3.827","article-title":"Prevalence and correlates of respiratory symptoms and disease in the 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