Abstract
BackgroundSocio-economic status, smoking, and exposure to increased levels of environmental air pollution are associated with adverse effects on respiratory health. We assessed the contribution of occupational exposures, smoking and outdoor air pollution as competing factors for the association between socio-economic status and respiratory health indicators in a cohort of women from the Ruhr area aged 55 at the time of investigation between 1985 and 1990.MethodsData of 1251 women with spirometry and complete questionnaire information about respiratory diseases, smoking and potential confounders were used in the analyses. Exposure to large-scale air pollution was assessed with data from monitoring stations. Exposure to small-scale air pollution was assessed as traffic-related exposure by distance to the nearest major road. Socio-economic status was defined by educational level. Multiple regression models were used to estimate the contribution of occupational exposures, smoking and outdoor air pollution to social differences in respiratory health.ResultsWomen with less than 10 years of school education in comparison to more than 10 years of school education were more often occupationally exposed (16.4% vs. 10.1%), smoked more often (20.3% vs. 13.9%), and lived more often close to major roads (26.0% vs. 22.9%). Long-term exposure to increased levels of PM10 was significantly associated with lower school education. Women with low school education were more likely to suffer from respiratory symptoms and had reduced lung function. In the multivariate analysis the associations between education and respiratory health attenuated after adjusting for occupational exposure, smoking and outdoor air pollution. The crude odds ratio for the association between the lung function indicator FEV1 less than 80% of predicted value and educational level (<10 years vs. >10 years of school education) was 1.83 (95% CI: 1.22–2.74). This changed to 1.56 (95% CI: 1.03–2.37) after adjusting for occupational exposure, smoking and outdoor air pollution.ConclusionWe found an association between socio-economic status and respiratory health. This can partly be explained by living conditions indicated by occupational exposure, smoking behaviour and ambient air pollution. A relevant part of the social differences in respiratory health, however, remained unexplained.
Highlights
Socio-economic status, smoking, and exposure to increased levels of environmental air pollution are associated with adverse effects on respiratory health
The association between respiratory health indicators and Socio-economic status (SES) was stronger for the indicators based on lung function measurements than for those based on questionnaire variables
(page number not for citation purposes) http://www.biomedcentral.com/1471-2458/8/179. These findings demonstrate that the situation of women in Germany with regards to environmental differences is similar to conditions in other industrialized regions
Summary
Socio-economic status, smoking, and exposure to increased levels of environmental air pollution are associated with adverse effects on respiratory health. Socio-economic status (SES) and exposure to increased levels of environmental air pollution are key issues in the discussion about social differences and health. Both have been linked to adverse health effects in recent years [1,2,3]. Because SES is considered as one of many important determinants of health, it has been included as a potential confounder or effect modifier in most epidemiological studies about adverse health effects of increased levels of air pollution [3,13,14]. Some recent studies have shown support for effect modification, with SES and air pollution-associated respiratory death [2,15,16]
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