Socioeconomic disadvantage over a lifetime is associated with lower lung function and is predictive of a significant number of years of lung function loss in adulthood and older age.
Socioeconomic conditions also affect lung function. This was found in a study of four European countries that included 70.5 thousand people aged 18-93 years (51% women).1 The paper, published in the European Respiratory Journal in mid-March 2021, comes from a project titled 'Lifepath'. The data of the 'Lifepath' study come from France, the UK, Switzerland and Portugal.
'Lifepath' is a research consortium funded by the European Commission to investigate the impact of socio-economic circumstances on healthy aging. The project considers the relative importance of life impacts and compares studies on risks in childhood and adulthood. After four years of work, more than 50 articles have already been published in major scientific journals. The data once again show that socioeconomic position is an independent risk factor for premature death and health problems.2
Difficult socioeconomic conditions over a person’s lifetime were associated with reduced forced expiratory volume in one second (FEV1) capacity. By the time people reached the age of 45, they had already lost 4-5 years of healthy lung function compared to their better-off peers.
After adjustment for other factors affecting lung function (such as smoking, obesity, physical inactivity, cardiovascular and respiratory disease), low educational attainment appeared to play the greatest role, followed by low occupational position. By the age of 65 and 85, lung function scores caught up a little, but were still 2-4 years (depending on the socioeconomic indicator) behind peers with high socioeconomic status. A sensitivity analysis with forced vital capacity (FVC) gave similar results as for FEV1.
Lung function is an important predictor of health and a marker of physical functioning in older age
Evidence from three large cohort studies shows that people with reduced lung function in early adulthood (FEV1 < 80% at 25-40 years) have a higher incidence of respiratory, cardiovascular and metabolic disease, a higher number of comorbidities, and increased premature mortality (from any cause).3
"The lung is extremely sensitive to an individual's life experiences, particularly environmental factors such as pollution, poverty, occupational exposure and smoking. Understanding the factors associated with a reduction in lung function may provide new insights into the impact of social factors on overall health. Social determinants of health are closely linked to socioeconomic position and systemic inequalities, both within and between countries," summarises researcher Prof. Sanja Stanojevic, PhD, who specialises in respiratory diseases, in an editorial commentary.4
A recent article in the British Medical Journal5 titled "If social factors are so important to health, shouldn't we ask patients about them?", gave hard figures for the UK that tried to quantify the overall effect of life circumstances. According to data from the Office for National Statistics (ONS), men in the most underprivileged areas were 9.5 years more likely to die than men in affluent areas, and for women it was 7.5 years. Men from the most deprived areas could also expect to live 18.9 years less in 'good' health, compared to 19.4 years for women.6
The paper highlighted the problem that while GPs in particular spend a lot of consultation time on their patients' socio-economic difficulties rather than purely medical ones, these are often not adequately and consistently documented. "When physicians do not ask patients about their social circumstances or do not record socio-economic data, they contribute to hiding these problems from the public and policy stakeholders", the authors fear.
References:
1. Rocha, V. et al. Life-course socioeconomic disadvantage and lung function: a multicohort study of 70 496 individuals. European Respiratory Journal 57, (2021).
2. LP HP | Lifepath. https://www.lifepathproject.eu.
3. Agustí, A., Noell, G., Brugada, J. & Faner, R. Lung function in early adulthood and health in later life: a transgenerational cohort analysis. Lancet Respir Med 5, 935–945 (2017).
4. Stanojevic, S. Socioeconomic disadvantage and lung health: accumulating evidence to support health policy. European Respiratory Journal 57, (2021).
5. Moscrop, A., Ziebland, S., Bloch, G. & Iraola, J. R. If social determinants of health are so important, shouldn’t we ask patients about them? BMJ 371, m4150 (2020).
6. Health state life expectancies by national deprivation deciles, England - Office for National Statistics.