Skip to main content

Advertisement

Log in

How far can we explain the social class differential in respiratory function? A cross-sectional population study of 21,991 men and women from EPIC-Norfolk

  • Pulmonary Diseases
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

The objective of this study is to investigate the association between occupational social class and respiratory function, as measured by forced expiratory volume in one-second (FEV1). We examined the cross sectional relationship between lung function and social class in a population study of 21,991 men and women aged 39–79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age–sex registers in 1993–1997. There was a significant socioeconomic gradient in age adjusted lung function with a difference of 0.37 in mean FEV1 in men and 0.20 in women, respectively between social class I and V. The age adjusted OR for having poor lung function was 4.13 (95% CI 2.66–6.42) in men and 2.64 (95% CI 1.74–3.99) in women for social class V compared to I. This difference was substantially attenuated after adjustment for height, weight, smoking status, respiratory illness, educational level, living in a deprived area, physical activity and plasma vitamin C levels. There was a strong socioeconomic gradient in respiratory function. In men the gradient appeared to be largely explained by smoking status and height; in women a large part of the gradient was explained by potentially modifiable factors. This suggests that socioeconomic inequalities in respiratory function may be preventable or modifiable and highlights factors for further exploration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

EPIC-Norfolk:

European prospective investigation of cancer and nutrition in Norfolk

FEV1 :

Forced expiratory volume in one-second

SES:

Socioeconomic status

References

  1. Acheson D. Independent inquiry into inequalities in health report. London: Stationery Office; 1998.

    Google Scholar 

  2. Adler NE, Boyce T, Chesney MA, Cohen S, Folkman S, Kahn RL, et al. Socioeconomic status and health: the challenge of the gradient. Am Psychol. 1994;49(1):15–24. doi:10.1037/0003-066X.49.1.15.

    Article  PubMed  CAS  Google Scholar 

  3. Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18(1):341–78. doi:10.1146/annurev.publhealth.18.1.341.

    Article  PubMed  CAS  Google Scholar 

  4. Hole DJ, Watt GCM, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996;313(7059):711–5.

    PubMed  CAS  Google Scholar 

  5. Schunemann HJ, Dorn J, Grant BJB, Winkelstein W Jr, Trevisan M. Pulmonary function is a long-term predictor of mortality in the general population : 29-year follow-up of the buffalo health study. Chest. 2000;118(3):656–64. doi:10.1378/chest.118.3.656.

    Article  PubMed  CAS  Google Scholar 

  6. Truelsen T, Prescott E, Lange P, Schnohr P, Boysen G. Lung function and risk of fatal and non-fatal stroke. The Copenhagen City heart study. Int J Epidemiol. 2001;30(1):145–51. doi:10.1093/ije/30.1.145.

    Article  PubMed  CAS  Google Scholar 

  7. Myint PK, Luben RN, Surtees PG, Wainwright NWJ, Welch AA, Bingham SA, et al. Respiratory function and self-reported functional health: EPIC-Norfolk population study. Eur Respir J. 2005;26(3):494–502. doi:10.1183/09031936.05.00023605.

    Article  PubMed  CAS  Google Scholar 

  8. Hegewald MJ, Crapo RO. Socioeconomic status and lung function. Chest. 2007;132(5):1608–14. doi:10.1378/chest.07-1405.

    Article  PubMed  Google Scholar 

  9. Jakes RW, Day NE, Patel B, Khaw KT, Oakes S, Luben R, et al. Physical inactivity is associated with lower forced expiratory volume in 1 second : European prospective investigation into cancer-Norfolk prospective population study. Am J Epidemiol. 2002;156(2):139–47. doi:10.1093/aje/kwf021.

    Article  PubMed  Google Scholar 

  10. Butland BK, Fehily AM, Elwood PC. Diet, lung function, and lung function decline in a cohort of 2,512 middle aged men. Thorax. 2000;55(2):102–8. doi:10.1136/thorax.55.2.102.

    Article  PubMed  CAS  Google Scholar 

  11. Carey Iain M, Strachan David P, Cook Derek G. Effects of changes in fresh fruit consumption on ventilatory function in healthy British adults. Am J Respir Crit Care Med. 1998;158(3):728–33.

    Google Scholar 

  12. McKeever TM, Scrivener S, Broadfield E, Jones Z, Britton J, Lewis SA. Prospective study of diet and decline in lung function in a general population. Am J Respir Crit Care Med. 2002;165(9):1299–303. doi:10.1164/rccm.2109030.

    Article  PubMed  Google Scholar 

  13. Schunemann HJ, McCann S, Grant BJB, Trevisan M, Muti P, Freudenheim JL. Lung function in relation to intake of carotenoids and other antioxidant vitamins in a population-based study. Am J Epidemiol. 2002;155(5):463–71. doi:10.1093/aje/155.5.463.

    Article  PubMed  Google Scholar 

  14. Wheeler BW, Ben-Shlomo Y. Environmental equity, air quality, socioeconomic status, and respiratory health: a linkage analysis of routine data from the health survey for England. J Epidemiol Community Health. 2005;59(11):948–54. doi:10.1136/jech.2005.036418.

    Article  PubMed  Google Scholar 

  15. Canoy D, Pekkanen J, Elliott P, Pouta A, Laitinen J, Hartikainen AL, et al. Early growth and adult respiratory function in men and women followed from the fetal period to adulthood. Thorax. 2007;62(5):396–402. doi:10.1136/thx.2006.066241.

    Article  PubMed  Google Scholar 

  16. Stein CE, Kumaran K, Fall CH, Shaheen SO, Osmond C, Barker DJ. Relation of fetal growth to adult lung function in South India. Thorax. 1997;52(10):895–9.

    Article  PubMed  CAS  Google Scholar 

  17. Dibben C, Sigala M, Macfarlane A. Area deprivation, individual factors and low birth weight in England: is there evidence of an “area effect”? J Epidemiol Community Health. 2006;60(12):1053–9. doi:10.1136/jech.2005.042853.

    Article  PubMed  Google Scholar 

  18. Kramer MS, Seguin L, Lydon J, Goulet L. Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol. 2000;14(3):194–210. doi:10.1046/j.1365-3016.2000.00266.x.

    Article  PubMed  CAS  Google Scholar 

  19. Shohaimi S, Welch A, Bingham S, Luben R, Day N, Wareham N, et al. Residential area deprivation predicts fruit and vegetable consumption independently of individual educational level and occupational social class: a cross sectional population study in the Norfolk cohort of the European prospective investigation into cancer (EPIC-Norfolk). J Epidemiol Community Health. 2004;58(8):686–91. doi:10.1136/jech.2003.008490.

    Article  PubMed  Google Scholar 

  20. Shohaimi S, Welch A, Bingham S, Luben R, Day N, Wareham N, et al. Area deprivation predicts lung function independently of education and social class. Eur Respir J.. 2004;24(1):157–61. doi:10.1183/09031936.04.00088303.

    Article  PubMed  CAS  Google Scholar 

  21. Day N, Oakes S, Luben R, Khaw KT, Bingham S, Welch A, et al. EPIC-Norfolk: study design and characteristics of the cohort. European prospective investigation of cancer. Br J Cancer. 1999;80(Suppl 1):95–103.

    PubMed  Google Scholar 

  22. Shohaimi S, Luben R, Wareham N, Day N, Bingham S, Welch A, et al. Residential area deprivation predicts smoking habit independently of individual educational level and occupational social class. A cross sectional study in the Norfolk cohort of the European investigation into cancer (EPIC-Norfolk). J Epidemiol Community Health. 2003;57(4):270–6. doi:10.1136/jech.57.4.270.

    Article  PubMed  CAS  Google Scholar 

  23. Elias P, Halstead K, Prandy K. CASOC: computer-assisted standard occupational coding. London: HMSO; 1993.

    Google Scholar 

  24. Arber S, Ginn J. Gender and inequalities in health in later life. Soc Sci Med. 1993;36(1):33–46. doi:10.1016/0277-9536(93)90303-L.

    Article  PubMed  CAS  Google Scholar 

  25. Arber S, Lahelma E. Inequalities in women’s and men’s ill-health: Britain and Finland compared. Soc Sci Med. 1993;37(8):1055–68. doi:10.1016/0277-9536(93)90440-F.

    Article  PubMed  CAS  Google Scholar 

  26. Smith MR, Kinmonth AL, Luben RN, Bingham S, Day NE, Wareham NJ, et al. Smoking status and differential white cell count in men and women in the EPIC-Norfolk population. Atherosclerosis. 2003;169(2):331–7. doi:10.1016/S0021-9150(03)00200-4.

    Article  PubMed  CAS  Google Scholar 

  27. Sargeant L, Wareham N, Bingham S, Day N, Luben R, Oakes S, et al. Vitamin C and hyperglycemia in the European prospective investigation into cancer–Norfolk (EPIC-Norfolk) study: a population-based study. Diabetes Care. 2000;23(6):726–32. doi:10.2337/diacare.23.6.726.

    Article  PubMed  CAS  Google Scholar 

  28. Sargeant LA, Khaw KT, Bingham S, Day NE, Luben RN, Oakes S, et al. Cigarette smoking and glycaemia: the EPIC-Norfolk study. Int J Epidemiol. 2001;30(3):547–54. doi:10.1093/ije/30.3.547.

    Article  PubMed  CAS  Google Scholar 

  29. McFadden E, Luben R, Wareham N, Bingham S, Khaw KT. Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European prospective investigation of cancer and nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol. 2008;23(7):449–58. doi:10.1007/s10654-008-9262-2.

    Article  PubMed  Google Scholar 

  30. Wareham NJ, Jakes RW, Rennie KL, Mitchell J, Hennings S, Day NE. Validity and repeatability of the EPIC-Norfolk physical activity questionnaire. Int J Epidemiol. 2002;31(1):168–74. doi:10.1093/ije/31.1.168.

    Article  PubMed  Google Scholar 

  31. Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, et al. Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European prospective investigation into cancer and nutrition (EPIC) study. Public Health Nutr. 2003;6(4):407–13. doi:10.1079/PHN2002439.

    Article  PubMed  Google Scholar 

  32. Khaw KT, Bingham S, Welch A, Luben R, Wareham N, Oakes S, et al. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. Lancet. 2001;357(9257):657–63. doi:10.1016/S0140-6736(00)04128-3.

    Article  PubMed  CAS  Google Scholar 

  33. Vuilleumier J, Keck E. Fluorometric assay of vitamin c in biological materials using a centrifugal analyser with fluorescence attachment. J Micronutrient Anal. 1989;5:25–34.

    CAS  Google Scholar 

  34. Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993;88(4):1973–98.

    PubMed  CAS  Google Scholar 

  35. Surtees PG, Wainwright NW, Khaw KT. Obesity, confidant support and functional health: cross-sectional evidence from the EPIC-Norfolk cohort. Int J Obes Relat Metab Disord. 2004;28(6):748–58. doi:10.1038/sj.ijo.0802636.

    Article  PubMed  CAS  Google Scholar 

  36. Davey Smith G, Hart C, Upton M, Hole D, Gillis C, Watt G, et al. Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality. J Epidemiol Community Health. 2000;54(2):97–103. doi:10.1136/jech.54.2.97.

    Article  PubMed  CAS  Google Scholar 

  37. Gunnell D, Whitley E, Upton MN, McConnachie A, Davey Smith G, Watt GCM. Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan family study. J Epidemiol Community Health. 2003;57(2):141–6. doi:10.1136/jech.57.2.141.

    Article  PubMed  CAS  Google Scholar 

  38. Wadsworth MEJ, Hardy RJ, Paul AA, Marshall SF, Cole TJ. Leg and trunk length at 43 years in relation to childhood health, diet and family circumstances; evidence from the 1946 national birth cohort. Int J Epidemiol. 2002;31(2):383–90. doi:10.1093/ije/31.2.383.

    Article  PubMed  CAS  Google Scholar 

  39. Myint PK, Luben RN, Surtees PG, Wainwright NWJ, Welch AA, Bingham SA, et al. Relation between self-reported physical functional health and chronic disease mortality in men and women in the European prospective investigation into cancer (EPIC-Norfolk): a prospective population study. Ann Epidemiol. 2006;16(6):492–500. doi:10.1016/j.annepidem.2005.04.005.

    Article  PubMed  Google Scholar 

  40. Wainwright NWJ, Surtees PG. Places, people, and their physical and mental functional health. J Epidemiol Community Health. 2004;58(4):333–9. doi:10.1136/jech.2003.012518.

    Article  PubMed  CAS  Google Scholar 

  41. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319–38. doi:10.1183/09031936.05.00034805.

    Article  PubMed  CAS  Google Scholar 

  42. Johnston ID. Effect of pneumonia in childhood on adult lung function. J Pediatr. 1999;135(2 Pt 2):33–7.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank the participants and general practitioners who took part in the study and the staff of EPIC-Norfolk.

Competing interests

The authors declare that they have no competing interests.

Funding

EPIC-Norfolk is supported by research programme grant funding from Cancer Research UK and the Medical Research Council with additional support from the Stroke Association, British Heart Foundation, and Research into Ageing.

Contributors

KTK, SB, and NW are principal investigators in the EPIC-Norfolk population study. SB is responsible for the dietary measurements and analyses. RL is responsible for data management and computing and data linkages for post coding. EM conducted the data analyses and wrote the paper with KTK with contributions from other co-authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emily McFadden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McFadden, E., Luben, R., Wareham, N. et al. How far can we explain the social class differential in respiratory function? A cross-sectional population study of 21,991 men and women from EPIC-Norfolk. Eur J Epidemiol 24, 193–201 (2009). https://doi.org/10.1007/s10654-009-9326-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-009-9326-y

Keywords

Navigation