Neighborhood Disadvantage Linked to Faster Lung Function Decline in Smokers

Researchers followed 2,362 current and former smokers aged 40 to 75 years who had at least 10 pack-years of smoking history in the Lovelace Smokers Cohort. Participants underwent spirometry approximately every 18 months from 2001 to 2017. Neighborhood disadvantage was assessed using census tract-level Social Vulnerability and Social Deprivation indices; mortality was tracked through October 2020. The mean baseline age was 56.3 years, and 73.6% of participants were women.

A 1-IQR increase in the Social Deprivation Index was associated with lower baseline FEV1 (−0.09 L) and FEV1:FVC ratio (−1.21 percentage points). Higher Social Vulnerability Index scores were associated with faster annual declines in FEV1 (−3.11 mL/year) and FEV1:FVC ratio (−0.05 percentage points/year), worse respiratory quality of life, and higher all-cause mortality (hazard ratio, 1.28; 95% CI, 1.08-1.53).

Mediation analyses suggested that smoking status and dietary patterns accounted for some selected associations, while baseline lung function and quality of life partially mediated associations with mortality. This observational study supports an association between neighborhood disadvantage and respiratory outcomes among ever-smokers, but cannot establish causality or show that addressing the identified mediators would change outcomes. Findings may not apply to people without a smoking history.