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Does educational level influence lung function decline (Doetinchem Cohort Study)?

Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.

CORRESPONDENCE: A. Spijkerman, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research (PB 101), P.O. Box 1, 3720 BA Bilthoven, The Netherlands. E-mail: annemieke.spijkerman{at}rivm.nl

Keywords: Education, lung function, sex, smoking, socioeconomic status

Received: July 22, 2008
Accepted May 9, 2009

Low socioeconomic status is associated with reduced lung function in adults. In addition, there are indications that lung function decline with age is accelerated in low socioeconomic groups, but, to date, findings have been inconclusive.

In order to investigate the relation between educational level, forced expiratory volume in 1 s (FEV₁) and decline in FEV₁ over time, linear mixed-effects models were fitted to baseline and 10-yr-follow-up data from the Doetinchem Cohort Study. The study population (26–66 yrs at baseline) consisted of 2,679 males and 3,026 females with an FEV₁ measurement in at least one of the three rounds of follow-up and information on relevant covariables. High educational level was used as the reference class.

Low educational level was associated with a higher prevalence of smoking and with a lower smoking-adjusted FEV₁ at baseline (-148 mL in males and -47 mL in females). In females, low educational level was associated with a faster FEV₁ decline (3.4 mL·yr^–1, age- and height-adjusted), which was not explained by smoking. In males, no differences in rates of decline between educational levels were observed.

FEV₁ decline was faster in less-educated females, independent of smoking. In males, FEV₁ decline did not differ between educational levels.