The role of socioeconomic status in the association of lung function and air pollution: a pooled analysis of three adult escape cohorts

Dirk Keidel*, Josep Maria Anto, Xavier Basagaña, Roberto Bono, Emilie Burte, Anne Elie Carsin, Bertil Forsberg, Elaine Fuertes, Bruna Galobardes, Joachim Heinrich, Kees De Hoogh, Debbie Jarvis, Nino Künzli, Bénédicte Leynaert, Alessandro Marcon, Nicole Le Moual, Audrey De Nazelle, Christian Schindler, Valérie Siroux, Morgane StempfeletJordi Sunyer, Sofia Temam, Ming Yi Tsai, Raphaëlle Varraso, Bénédicte Jacquemin, Nicole Probst-Hensch

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

15 Citations (Scopus)
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Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO2. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO2 associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function.

Original languageEnglish
Article number1901
Number of pages14
JournalInternational Journal of Environmental Research and Public Health
Issue number11
Publication statusPublished - 1 Jun 2019


  • Air pollution
  • Environmental equality
  • Europe
  • Lung function
  • Socioeconomic position


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