Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study

Abstract

IntroductionIndividual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. ObjectiveOur aim was to assess the association between neighborhood-level SES and lung function. MethodsWe cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. ResultsGreater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: −30 mL (95% CI: −97, 36), βQ3vsQ1: −70 mL (95% CI: −135, −4) and βQ4vsQ1: −104 mL (95% CI: −171, −36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. ConclusionNeighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.