Life-Course Socioeconomic Disadvantage and Lung Function in Older Adults: A Multicohort Study of 70 496 Participants from Four European Countries

Abstract

Background: Lung function is an important predictor of health and a marker of physical functioning at older ages. This study aimed to quantify the years of lung function lost according to disadvantaged socioeconomic conditions across life-course. Methods: This multicohort study used harmonised individual-level data from six European cohorts with information on life-course socioeconomic disadvantage and lung function assessed by FEV1 and FVC. 70496 participants (51% women) aged 18-93 years were included. Socioeconomic disadvantage was measured in early life (low paternal occupational position), early adulthood (low educational level), and adulthood (low occupational position). Risk factors for poor lung function (i.e., smoking, obesity, sedentary behaviour, cardiovascular and respiratory diseases) were included as potential mediators. The years of lung function lost due to socioeconomic disadvantage were computed at each life stage. Findings: Socioeconomic disadvantage during life-course was associated with a lower FEV1. By age 45, individuals experiencing disadvantaged socioeconomic conditions had lost 4 to 5 years of healthy lung function vs their more advantaged counterparts (low educational level: -4.36 [95% CI -7.33 to -2.37] for men and -5.14 [-10.32 to -2.71] for women; low occupational position: -5.62 [-7.98 to -4.90] for men and -4.32 [-13.31 to -2.27] for women), after accounting for the risk factors for lung function. By ages 65 and 85, the years lung function lost due to socioeconomic disadvantage decreased by 2 to 4 years, depending on the socioeconomic indicator. Interpretation: Life-course socioeconomic disadvantage is associated with lower lung function and predicts a considerable number of years of lung function loss in adulthood and older ages. Funding: Foundation for Science and Technology; European Commission; University of Lausanne; Medical Research Council; US National Institute on Aging; NordForsk; Helsinki Institute of Life Science; GlaxoSmithKline; Swiss National Science Foundation; Agence Nationale de la recherche. Declaration of Interests: None declared. Ethics Approval Statement: The relevant local or national ethics committees approved each study, and all participants gave written informed consent to participate.