The impact of neighbourhood material and social disadvantage on respiratory health across Canada

While smoking and genetic predisposition are known to confer an increased risk of lung diseases, less is known about the socioeconomic determinants of respiratory health. Disadvantages experienced at the neighbourhood level may contribute to poor lung outcomes. Our objective was to quantify the impact of neighbourhood disadvantage on respiratory outcomes in a general population cohort.

1449 adults enrolled in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study were followed for 3 years with repeat pulmonary function and cardiopulmonary exercise testing. Chest computed tomography (CT) imaging was obtained at baseline. The Material and Social Deprivation Index was used to measure neighbourhood disadvantage. Regression models were used to quantify the association between neighbourhood disadvantage and pulmonary function, peak exercise capacity, quantitative CT measures, respiratory symptom scores, respiratory-related exacerbation events and mortality.

When compared to individuals residing in neighbourhoods with the highest privilege, those residing in the most materially and socially disadvantaged neighbourhoods had significantly worse forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), FEV₁/FVC, air trapping, peak exercise oxygen consumption and respiratory symptoms (all p<0.05). Over a 3-year period, they also had significantly worse FEV₁ (β= -20.960 mL·year^-1, p=0.012) and FVC (β= -25.635 mL·year^-1, p=0.042) decline. There were no significant relationships between neighbourhood disadvantage and quantitative CT measures, exacerbations or mortality.

Residence in the most materially and socially disadvantaged neighbourhood is associated with worse lung function and exercise outcomes, highlighting a population particularly vulnerable to chronic airways diseases.