Chest Radiograph-Derived Age Acceleration as an Early Marker of Pulmonary Dysfunction in Middle-Aged Asians.

BACKGROUND: Deep learning-derived, chest radiographic (CXR) age may capture subclinical structural changes associated with spirometric impairment. RESEARCH QUESTION: Is CXR-based accelerated aging associated with the prevalence and incidence of preserved ratio impaired spirometry (PRISm) and obstructive lung disease (OLD)? STUDY DESIGN AND METHODS: This retrospective study included Korean adults who underwent CXRs and spirometry during regular health check-ups between 2006 and 2019. Participants were categorized into decelerated (<-2.0 years), reference (-2.0 to 1.9 years), or accelerated (≥2.0 years) aging groups according to CXR-Lung-Risk scores relative to chronological age derived from baseline CXRs. Prevalent PRISm (FEV1 <80% predicted with FEV1/FVC ≥0.70) and OLD (FEV1/FVC <0.70) were defined based on baseline spirometry and assessed using multivariable multinomial logistic regression. Incident PRISm and OLD were evaluated among participants with normal baseline spirometry using follow-up spirometry data through December 31, 2022, and associations were estimated using multivariable Cox proportional hazards models. RESULTS: Among 231,278 participants (mean age, 50.7±8.8 years; 55.0% men), the prevalence of PRISm and OLD was 2.2% (5,161/231,278) and 4.6% (10,557/231,278), respectively. Compared with those in the reference group, participants with accelerated aging had higher odds of prevalent PRISm (adjusted odds ratio [OR], 1.37; 95% CI [confidence interval]: 1.28-1.46) and OLD (adjusted OR, 1.58; 95% CI: 1.51-1.65). In the longitudinal analysis including 104,158 participants (median follow-up, 4.3 years), accelerated aging was associated with higher risks of incident PRISm (adjusted hazard ratio [HR], 1.37; 95% CI: 1.27-1.48) and OLD (adjusted HR, 1.28; 95% CI: 1.20-1.37). Associations were directionally consistent across subgroups defined by age, sex, smoking status, and body mass index, with most subgroup analyses remaining statistically significant. INTERPRETATION: CXR-derived accelerated aging was associated with both current and future PRISm and OLD. These findings support a potential complementary role for routine CXRs in opportunistic identification of pulmonary dysfunction. CLINICAL TRIAL REGISTRATION: N/A.