The Impact of Neighborhood Material and Social Disadvantage on Respiratory Health Across Canada

Abstract Rationale: While inhalational exposures and genetic predisposition confer an increased risk of lung diseases, less is known about the socioeconomic determinants of respiratory health. Both material and social disadvantages experienced at the neighborhood level may conceivably contribute to poor lung health outcomes. We aimed to quantify the impact of neighborhood disadvantage on lung function, exercise capacity, and respiratory symptoms in a general population cohort. Methods: Participants were enrolled in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study and followed for three years with repeat pulmonary function, cardiopulmonary exercise testing, and assessment of respiratory symptoms using the St. George's Respiratory Questionnaire (SGRQ). The Material and Social Deprivation Index (MSDI) was used as a measure of neighborhood disadvantage, with the cohort separated into five groups (C1 to C5, with C1 representing the least materially and socially disadvantaged and C5 representing the most). Multivariable linear regression models were used to quantify the association between MSDI groups and baseline pulmonary function (post-bronchodilator FEV1/FVC, FEV1 and FVC %predicted), peak exercise capacity (V'O2 [mL/kg/min], V'O2 %predicted), ventilatory response to exercise (nadir V'E/V'CO2), and SGRQ score adjusting for possible covariates such as age, sex, height, weight, race, cigarette and cannabis smoking. We also used multivariable linear regression models to assess the association between MSDI group and rate of FEV1 and FVC change from baseline to 36 months. Results: There were 1,449 participants with baseline MSDI enrolled. Compared to those in the least disadvantaged neighborhoods, individuals living in the most disadvantaged neighborhoods were younger (median age 65 vs. 67 years), more likely to be of non-White race (9% vs. 3%), and more likely to currently smoke cigarettes (32% vs. 6%) or cannabis (12% vs. 4%). Compared to the least disadvantaged, the most disadvantaged had lower FEV1/FVC (p=0.002), FEV1 %predicted (p<0.001), FVC %predicted (p=0.006), peak V'O2 in ml/kg/min and %predicted (both p<0.001), higher exercise ventilatory inefficiency as measured by nadir V'E/V'CO2 (p<0.001), and worse SGRQ scores (p=0.002) (Table 1). The most disadvantaged also had faster decline of FEV1 (p=0.035) and FVC (p=0.029) compared to the least disadvantaged. Conclusions: Living in the most materially and socially disadvantaged neighborhoods has a detrimental impact on lung function and its decline, exercise capacity, and respiratory symptoms in older Canadians. This may indicate that these individuals are at greater risk for developing chronic lung diseases over time. Increased screening of individuals living in disadvantaged neighborhoods may be warranted for lung disease prevention and treatment.

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