Prevalence, Risk Factors of Preserved Ratio Impaired Spirometry in adult in plateau: A Cross-Sectional Study

Junjie Xia; Yu Qiu; Ling Huang; Wenjun Li; Xingxiong Zou; Xiaoqian Wang; Xiaoli Hou; Yuting Chen; Haishi Xue; Runjiao Chen; Lingna Li; Ke Yi; Jincheng Wang; Wenying Xie

doi:10.1371/journal.pone.0318546

Peer Review History

Original SubmissionJune 17, 2024
17 Jun 2024 Author Response https://doi.org/10.1371/journal.pone.0318546.r001
23 Sep 2024 Decision Letter - Nishi Haider, Editor Dear Dr. Xia, plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. 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Please note that supplementary tables (should remain/ be uploaded) as separate ""supporting information"" files".?> Additional Editor Comments: Authors are requested to sincerely revise the manuscript as per the suggestions of the respected reviewers and have to submit the revised version of the manuscript along with your response to each of the reviewers comments. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Partly Reviewer #2: No Reviewer #3: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No Reviewer #3: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** Reviewer #1: First, I appreciate the authors for investigated the Prevalence, Risk Factors of Preserved Ratio Impaired Spirometry in adult in plateau. However, there are several areas of concern that need to be addressed before the paper can be indexed. In introduction: The introduction should clearly state the need for the study. In Page No-2, line-50: “Studies1 found that the prevalence of COPD was higher in high-altitude areas.” At least 2 or more than 2 citations should be quoted for'studies’. In Page No-3, line-57: “Previous studies have shown that individuals with 58 PRISm…….4,5,6” –It would be good if authors included the place of study for these references. In Page No-4, line-85: “According the guideline, we used the survey used uniform methods, procedures….”. – It would be good if the authors state the name of the guideline in the manuscript. In Page No-6, line-157: “This study was consistent with most previous studies.” – The references should be added for most previous studies. Reviewer #2: -The study relies on self-reported data from participants for key variables like smoking history, history of tuberculosis, and medical conditions (diabetes, hypertension). This introduces potential recall bias, where participants may inaccurately report their histories. This could especially affect data related to smoking habits and tuberculosis history, as both factors have strong social and stigma-related influences -Although the study briefly mentions different prevalence rates among ethnic groups (Han and Tibetan), it doesn’t explore whether these differences are statistically significant or delve into the possible cultural or genetic factors influencing these rates. Reviewer #3: The topic sounds good , and the methods sounds clear Just some main points : 1.Sample size calculation and power analysis were not done. 2. I can not find the tables (table 1 and table 2) to evaluate the results. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: No Reviewer #3: Yes: Asmaa Abd Elhameed ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0318546.r002
Revision 1
24 Oct 2024 Author Response Ethics was approved by The Third Hospital of Mianyang's Ethics Committee. As part of the ethics review process, participant confidentiality restrictions prohibit the authors from making the data set publicly available. During the consent process, participants were explicitly guaranteed that the data would only be seen my members of the study team. For any discussions about the data set please contact The Third Hospital of Mianyang's Research Governance:578012475@qq.com Reviewer 1: 1.In introduction: The introduction should clearly state the need for the study. Thank you very much for recognition of our work. We really appreciated this advice. COPD is a major public health concern, and PRISm is currently considered to be pre-COPD, which can progress to COPD in some people over time. The incidence of COPD is higher in plateau areas, especially in Asia. Therefore, understanding the prevalence and risk factors of PRISm in highland areas is helpful to prevent COPD. 2.In Page No-2, line-50: “Studies1 found that the prevalence of COPD was higher in high-altitude areas.” At least 2 or more than 2 citations should be quoted for'studies’. We really appreciated this advice; We added two more citations for a higher incidence of COPD in high areas. 3.In Page No-3, line-57: “Previous studies have shown that individuals with 58 PRISm…….4,5,6” –It would be good if authors included the place of study for these references. We really appreciated this advice; We added the place of study. 4.In Page No-4, line-85: “According the guideline, we used the survey used uniform methods, procedures….”. – It would be good if the authors state the name of the guideline in the manuscript. We really appreciated this advice; We added the name of the guideline. 5.In Page No-6, line-157: “This study was consistent with most previous studies.” – The references should be added for most previous studies.. We really appreciated this advice; The references included references 9 and 16 Reviewer 2: 1.The study relies on self-reported data from participants for key variables like smoking history, history of tuberculosis, and medical conditions (diabetes, hypertension). This introduces potential recall bias, where participants may inaccurately report their histories. This could especially affect data related to smoking habits and tuberculosis history, as both factors have strong social and stigma-related influences. We really appreciated this advice.Our questionnaire was conducted in a quiet room by a trained respiratory physician. All patient information is kept confidential and is asked based on a standardized questionnaire. We also reviewed the participants' medical records. This reduces recall bias to some extent. However, due to the backward medical conditions in Tibetan areas on the plateau, many participants' medical records are incomplete, and some patients' medical records in other places cannot be provided, which will indeed lead to recall bias. Thank you very much for the comments. In the future work, we will pay more attention to this problem and make the obtained data more authentic and credible. 2.Although the study briefly mentions different prevalence rates among ethnic groups (Han and Tibetan), it doesn’t explore whether these differences are statistically significant or delve into the possible cultural or genetic factors influencing these rates. We really appreciated this advice.In the single factor analysis, we found that the prevalence of different ethnic groups was inconsistent, but after the multi-factor analysis, it was found that ethnicity was not an independent risk factor. That's why we didn't talk about nationalities. Reviewer 3: 1.Sample size calculation and power analysis were not done. We really appreciated this advice. Since there is no available research data for reference in China, we use a single proportional formula to calculate the sample size. N=Z2P (1-P) /d2. Then the sample size is 544 based on the total population. Considering that the loss of follow-up rate was 10%, the final sample size was 560. 2. I can not find the tables (table 1 and table 2) to evaluate the results. We really appreciated this advice.We have put Table 1 and Table 2 in the manuscript. Attachments Attachment Submitted filename: Response to Reviewers.doc* https://doi.org/10.1371/journal.pone.0318546.r003
11 Dec 2024 Decision Letter - Nishi Haider, Editor Dear Dr. Xia, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ============================== Please submit your revised manuscript by Jan 25 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Nishi Shahnaj Haider, Ph.D. Guest Editor PLOS ONE Additional Editor Comments (if provided): Reviewers have recommended consideration of the manuscript following major revision. Authors are expected to revise the manuscript as per the reviewers comments. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: No ****** Reviewer #1: (No Response) Reviewer #2: Recommendations for Improvement: -Conduct Power Analysis: Include a detailed power analysis to support the adequacy of the sample size. -Address Recall Bias: Highlight steps taken to minimize recall bias more explicitly and suggest future improvements. -Explore Ethnic Variations: Delve deeper into the differences observed between ethnic groups, providing statistical significance and possible explanations. -Enhance Discussion: Expand the discussion to include comparisons with global studies and implications for public health policy. -Improve Data Accessibility: Consider anonymizing the dataset to allow partial access for peer verification while adhering to ethical guidelines. -Language and Presentation: Proofread for grammar and typographical errors to enhance readability and professionalism. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: Yes: Dr. Mais Odai ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0318546.r004
Revision 2
2 Jan 2025 Author Response Answers to reviewers Changes in the main text indicated in red Reviewer 2: 1.-Conduct Power Analysis:Include a detailed power analysis to support the adequacy of the sample size. Thank you very much for recognition of our work. We really appreciated this advice. This is a cross-sectional study,since there was no available research data for reference in China, we used a single proportional formula to calculate the sample size. N=Z2P (1-P) /d2. Then the sample size was 544 based on the total population. Considering that the loss of follow-up rate was 10%, the final sample size was 560(Z=1.96,p=0.15,d=0.2p). 2.Address Recall Bias:Highlight steps taken to minimize recall bias more explicitly and suggest future improvements. We really appreciated this advice.Our questionnaire was conducted in a quiet room by a trained respiratory physician. The uniformly trained respiratory physicians asked the respondents face to face and asked questions in the independent and quiet room according to the questionnaire items.At the same time, we reviewed the respondents' medical records. If there was any discrepancy between the medical records and the responses, the medical records were taken as the reference. 3.Explore Ethnic Variations:Delve deeper into the differences observed between ethnic groups, providing statistical significance and possible explanations. We really appreciated this advice.Our previous research has found that the prevalence rate of COPD in Han population was higher than that in Tibetan population, suggesting that the prevalence of COPD may be related to ethnic and racial differences. Havryk et al studied Sherpas living at an average altitude of 4000 meters, showing that their lung capacity increased by about 12% compared to Caucasians. Wood conducted lung function studies on Ladakh and Tibetans living between 3300 and 4500 meters above sea level. Spirometry results in both groups showed high values of maximal mid-expiratory ﬂow are between 130% and 150% of predicted, and a FEV1/FVC ratio of 115%. These studies suggest that, over time and over multiple generations, highaltitude populations have undergone physiological and genetic adaptations to extreme altitudes in response to chronic hypoxia and generally high-intensity exercise. Living at high altitudes is associated with accelerated lung function decline in populations with low daily smoking rates. However, the lung function of the Han population is lower than that of the Tibetan population, and is more susceptible to decline due to environmental factors.However, In this study, We found no statistically significant difference in prevalence among different ethnic groups. To find out why, prospective long-term follow-up studies may be needed. 4.Enhance Discussion:Expand the discussion to include comparisons with global studies and implications for public health policy. We really appreciated this advice. At present, there is a lack of global data on PRISm studies in plateau areas, and the results of this study are similar to those of other studies, which found that smoking, age, BMI≥30, diabetes, history of tuberculosis, hypertension, white blood cell count, and red blood cell volume distribution width are correlated with PRISm. The purpose of this study is to supplement some of the plateau data for the global PRISm research.In highland areas, we can prevent PRISm development by controlling weight, smoking, diabetes, and high blood pressure. A history of tuberculosis may be a specific risk factor for PRISm in the plateau region of China. We can also detect PRISm early by focusing on the WBC and RDW of the population. 5.Improve Data Accessibility:Consider anonymizing the dataset to allow partial access for peer verification while adhering to ethical guidelines. We really appreciated this advice.Ethics was approved by The Third Hospital of Mianyang's Ethics Committee. As part of the ethics review process, participant confidentiality restrictions prohibit the authors from making the data set publicly available. During the consent process,participants were explicitly guaranteed that the data would only be seen my members of the study team. For any discussions about the data set please contact The Third Hospital of Mianyang's Research Governance:578012475@qq.com. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.doc* https://doi.org/10.1371/journal.pone.0318546.r005
19 Jan 2025 Decision Letter - Nishi Haider, Editor Prevalence, Risk Factors of Preserved Ratio Impaired Spirometry in adult in plateau: A Cross-Sectional Study PONE-D-24-22504R2 Dear Dr. Xia, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Nishi Shahnaj Haider, Ph.D. Guest Editor PLOS ONE Additional Editor Comments (optional): Reviewers are agreed with the revisions been submitted for all the given comments. Therefore, the decision is to 'Accept' the manuscript for publication. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: Dear Author All recommendations have been made correctly thank you very much ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0318546.r006
Formally Accepted
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