Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Wayne T. Sanderson, PhD, MS, CIH

Committee Member

Steven Browning, PhD

Committee Member

Susan E. Spengler, MD, MSPH, FACOEM

Committee Member

Timothy S. Prince, MD, MSPH


Objective: This study examines the prevalence of restrictive spirometry in Eastern Kentucky and its association among men and women with various demographic and exposure (occupational and environmental) factors.

Methods: A cross sectional, cluster sample (N = 685) of participants from Letcher and Harlan Counties, aged 21 and over, answered a questionnaire focused on risk factors for respiratory health outcomes including questions on demographic, health, occupational, and environmental exposures variables. Pulmonary function tests were administered to all participants with no significant cardiovascular or cerebrovascular events within the past 30 days. Log-binomial regression was used to calculate prevalence ratios (PRs) adjusted for multiple covariates.

Results: The prevalence of restricted spirometric pattern (RSP) among men and women was 24.3% and 30.6%, respectively. RSP prevalence was particularly high among men and women with comorbidities. Significant associations for restricted spirometry among women included Age35-64: adjusted prevalence (PR: 5.49, 95% CI 1.69 to 17.8, p=0.005), Age≥65 (PR:7.23, 95% CI 2.20 to 23.7, p=0.001), widowed, single or divorced women (PR: 1.78, 95% CI 1.02 to 3.10, p=0.043), one comorbidity (PR: 1.79, 95% CI: 1.14 to 2.80) and obesity (PR: 2.21, 95% CI 1.05 to 4.64, p=0.036). Significant associations for restricted spirometry among men was obesity (PR: 2.68, 95% CI 1.05 to 6.80, p=0.039).

Conclusions: The prevalence of RSP in Central Appalachia is substantially higher when compared with previous literature. Increased RSP in our cohort is multifactorial but may be due to higher prevalence of obesity and comorbid conditions, which is in line with previous studies. Occupational and environmental exposures did not show association with RSP despite many participants living in proximity to coal mines and mining activities.

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