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Benefits of improved air quality and reduced smoking have not been equally distributed according to socioeconomic status

Income- and education-based disparities in pulmonary health in the United States have persisted and potentially worsened during the past six decades, according to a study published online May 28 in JAMA Internal Medicine.

Adam W. Gaffney, M.D., M.P.H., from Cambridge Health Alliance in Massachusetts, and colleagues used data from the National Health and Nutrition Examination Surveys and predecessor surveys (1959 to 2018) to assess long-term trends in socioeconomic disparities in respiratory disease prevalence, pulmonary symptoms, and pulmonary function. The analysis included 215,399 participants aged 6 to 74 years.

The researchers found that socioeconomic disparities in respiratory symptoms persisted or worsened from 1959 to 2018. From 1971 to 1975, 44.5 percent of those in the lowest income quintile reported dyspnea on exertion versus 26.4 percent of those in the highest quintile compared with 48.3 and 27.9 percent, respectively, in 2017 to 2018. Disparities in cough and wheezing also increased over time. After 1980, asthma prevalence rose for all children but increased more sharply among poorer children. Additionally, age- and sex-adjusted income-based disparities in diagnosed chronic obstructive pulmonary disease widened over time (from 4.5 percentage points in 1971 to 1975 to 11.3 percentage points in 2013 to 2018).

“Income- and education-based disparities in respiratory health have persisted, and potentially worsened, despite secular improvements in air quality and tobacco use, suggesting that the benefits of these improvements have not been equitably enjoyed,” the authors write. “Social class may function as an independent determinant of lung health.”

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