Clinical Research Study
Neighborhood Socioeconomic Deprivation in Young Adulthood and Future Respiratory Health: The CARDIA Lung Study

https://doi.org/10.1016/j.amjmed.2021.07.048Get rights and content

Abstract

Purpose

There are limited data on the relationship between neighborhood level factors and their association with lung health independent of individual socioeconomic status. We sought to determine whether baseline neighborhood level socioeconomic deprivation in young adults is associated with greater 20-year decline in lung function and higher risk of future lung disease, independent of baseline individual income, education, and smoking status.

Methods

This multicenter population-based cohort study included 2689 participants in Coronary Artery Risk Development in Young Adults (CARDIA) for whom neighborhood deprivation was determined at year 10 (baseline for study) and who had complete lung function measurements at years 10 and 30. Baseline neighborhood deprivation was defined using 1990 Census blocks as a combination of 4 factors involving median household income, poverty level, and educational achievement. The outcomes were decline in lung function over 20 years (year 10 to 30) and odds of emphysema (year 25).

Results

In multivariable regression models, greater baseline neighborhood deprivation was associated with greater decline in lung function (−2.34 mL/year excess annual decline in forced expiratory volume in 1 second (FEV1) in the highest versus lowest deprivation quartile (P = .014)). Furthermore, baseline neighborhood deprivation was independently associated with greater odds of emphysema (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.42-6.30).

Conclusions

Residence in neighborhoods with greater socioeconomic deprivation in young adulthood, independent of individual income and smoking, is associated with greater 20-year decline in forced expiratory volume in 1 second and higher risk of future emphysema.

Section snippets

Background

Lung function is dependent on physiologic factors such as body habitus, age, and sex, and maximum pulmonary function is reached during the third decade of life.1 However, there is a growing body of evidence that a broader set of social determinants of health in early adulthood influence lung function. Lower socioeconomic status is associated with chronic obstructive pulmonary disease.2 Adults in Scotland with higher socioeconomic status had a higher forced expiratory volume in 1 second (FEV1)

Study Design and Participants

CARDIA recruited 5115 participants ages 18-30 years old from 1985 to 1986. Participants have been examined up to 8 times through 2015-2016 (30 years). Men and women were recruited via community-based strategies (random-digit telephone dialing and door-to-door) and population registries in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and from a health plan in Oakland, California. The CARDIA study was approved by the institutional research board at each field center.

Participant Characteristics

Baseline demographic information is shown in Table 1. Of the 2689 participants, 44% were men, 56% were women, 46% were black and 54% were white. Characteristics of participants who were excluded compared with those included are documented in the online supplement (Table E1, available online). Participants living in neighborhoods with higher deprivation scores at baseline were more often black, with the most deprived quartile having 82% black population compared with 15% in the least-deprived

Discussion

In this prospective population-based cohort study, we report that participants who lived in the most socioeconomically deprived neighborhoods during early adulthood experienced an accelerated decline in lung function and higher odds of future emphysema over 20 years, independent of individual socioeconomic status, as well as cumulative smoking burden and change in BMI over time. We report a stronger association in Black participants, possibly due to additional neighborhood level factors not

Conclusion

In a large, population-based cohort study of healthy adults, we report that residence in neighborhoods with greater deprivation during early adulthood is associated with a 20-year accelerated decline in lung function and higher odds of emphysema. Further studies to investigate the interplay of neighborhood and individual level factors on lung health are needed. These studies will also be informative for targeted interventions to improve lung health and intercept disease.

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    Funding: The CARDIA Lung study is funded by NHLBI (R01 HL122477). The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201800005I and HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I).  This manuscript has been reviewed by CARDIA for scientific content.

    Conflicts of Interest: ST, KNK, LAC, PG-L, DRJ, DM, TMP, MRC report none. MTD reports grants from the American Lung Association, National Institutes of Health (NIH), and Department of Defense and personal fees from AstraZeneca, GlaxoSmithKline, PulmonX, and Teva. SRR reports grants from the National Institutes of Health (NIH), American Lung Association, and AstraZeneca; personal fees from GlaxoSmithKline; and being a GSK Nucala speaker; AZ biologics in COPD study investigator, NICH PRECisE investigator, and an ACRC investigator. GRW reports grants from National Institutes of Health (NIH), Boehringer Ingelheim, BTG Interventional Medicine, and Janssen Pharmaceuticals; personal fees from Boehringer Ingelheim, Janssen Pharmaceuticals, PulmonX, Novartis, Philips, Vertex, and is a cofounder and equity share holder of Quantitative Imaging Solutions; his spouse is an employee of Biogen. RK reports grants from the National Institutes of Health (NIH) and American Lung association, and personal fees from AstraZeneca, GlaxoSmithKline, and CVS Caremark.

    Authorship: All authors had access to the data and a role in writing this manuscript.

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