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