Americans’ Lung Health: The Poor Suffer Most

By Alan Mozes
HealthDay reporter

TUESDAY June 1, 2021 (HealthDay News) – The health of your lungs can have a lot to do with the size of your bank account, says a major new study.

The discovery follows a six-decade examination of the risk of lung disease in more than 215,000 American children and adults.

In general, the poorest Americans continue to have poorer lung health than their wealthier peers. In some cases, the gap between the rich and the poor is widening.

“We looked at long-term trends in socio-economic inequalities in the lung health of Americans,” said lead author of the study, Dr. Adam Gaffney. “Specifically, we looked at the prevalence of pulmonary symptoms such as shortness of breath, diagnoses of lung diseases like asthma or COPD. [chronic obstructive pulmonary disease] and lung volumes. “(The latter refers to the amount of air retained in the lungs during the various phases of respiration.)

The Bottom Line: “The differences in lung health between rich and poor Americans have persisted over the past six decades and in some cases have actually grown larger,” said Gaffney, assistant professor of medicine at Harvard Medical School. and specialist in pulmonary and critical diseases. care specialist at the Cambridge Health Alliance in Boston.


The study appears in the May 28 issue of JAMA Internal Medicine.

Investigators looked at survey data collected by the US Centers for Disease Control between 1959 and 2018. Participants ranged from 6 to 74 years old.

The surveys focused on smoking habits and lung health. Lung function tests were also done.

After matching the responses to income and education, the study team concluded that while large disparities in lung health existed in the 1960s, by some measures, the risk gaps widened. .

A striking example: smoking. Gaffney and colleagues note that smoking behavior actually had little to do with income level before the 1980s. But the team found a landscape that changed significantly over time, with the wealthiest Americans predominant. Beneficiaries: Their smoking rate fell from around 63% in 1971-1975 to just 34% in 2018.

In contrast, over the same period, smoking rates have remained essentially stable between 56% and 58% among the bottom five in terms of income.


Following a similar trend, the risk of wheezing fell among those with larger wallets and better education from the late 1980s, while poor Americans saw little change.

By other criteria, in the early 1970s, about 45% of the poorest Americans reported shortness of breath when exercising. Today that figure is around 48%.

But only 26% of the richest Americans said the same thing then, and today that figure is only 28%.

And while the risk of asthma in children has increased regardless of income, it has increased more dramatically among the poor. Today, only 7% of the richest children in the country suffer from respiratory problems, compared to almost 15% of the poorest children in the country.

In adults, a long-standing wealth gap in COPD risk and lung volume health has also worsened, the team observed.

“There is a growing class divide in tobacco use in the United States that explains some, but not all, of the differences we have seen,” Gaffney said. “Other factors, such as uneven exposure to air pollution or unsanitary working conditions, or inequitable access to health care, may also contribute.”


“Overall, our results suggest that although air pollution has improved over the past decades and access to health care has expanded, the means for good lung health do not exist. are not equally appreciated by all Americans, ”Gaffney added.

Although the study was conducted before the emergence of COVID-19, Gaffney said the pandemic has highlighted the health divide for millions of underprivileged Americans. Long-standing inequalities in lung health have made many people vulnerable to COVID pneumonia, he noted.

Dr Sarath Raju, co-author of an accompanying editorial, was not surprised by the results. However, “it is still deep to see the magnitude of these disparities and how they have only grown over the years,” he said.

“These disparities in lung health are likely to have a profound impact on people of all ages in the United States if steps are not taken to address them,” noted Raju, assistant professor of pulmonary medicine and care. intensive at Johns Hopkins University. in Baltimore.


Raju said making smoking cessation and prevention resources more affordable would be a helpful step. But he warned that much more research will be needed to better understand the racial, environmental and institutional forces at play.


More information

There is more on lung health at the American Lung Association.

SOURCES: Adam Gaffney, MD, MPH, assistant professor, medicine, Harvard Medical School, and pulmonary and critical care specialist, Cambridge Health Alliance, Boston; Sarath Raju, MD, MPH, assistant professor, medicine, division of pulmonary and critical care medicine, Johns Hopkins University, Baltimore; JAMA Internal Medicine, May 28, 2021

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