Disparities in lung function trajectories among tobacco-exposed individuals

The relationship of social determinants of health (SDOH), environmental exposures and medical history to lung function trajectories is underexplored. A better understanding of these relationships could inform preventive strategies for lung health.

We analysed data from COPDGene, a US longitudinal, observational study. Participants were tobacco-exposed (≥10 pack-years of smoking) non-Hispanic Black and non-Hispanic White adults aged 45-80 years. We analysed 2990 males and 2945 females, using Bayesian trajectory modelling on post-bronchodilator forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC). We applied multinomial logistic regression to assess the association of SDOH, environmental exposures and medical history with lung function trajectories.

Six trajectories were identified within each sex. Non-Hispanic Black race was more prevalent in trajectories characterised by lower FEV1 and FVC values (ie, lower lung function trajectories) compared with non-Hispanic White adults. In adjusted models, non-Hispanic Black race, residence in the Southeastern USA, lifetime asthma and a father with COPD were associated with significantly higher odds of the lowest trajectory (ie, trajectory six vs the reference trajectory) for both sexes. Higher income and private insurance showed inverse associations with lower lung function trajectories. The Social Vulnerability Index socioeconomic theme (based on census-level poverty, unemployment, income and educational attainment) was associated with the lowest trajectory in males.

Significant disparities in lung function trajectories exist between non-Hispanic Black adults and non-Hispanic White adults. Individual- and community-level factors are associated with lower lung function trajectory in people exposed to tobacco.