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Life-course socioeconomic status and lung function in adulthood: a study in the EPIPorto cohort
  1. Vânia Rocha1,
  2. Silvia Stringhini2,3,
  3. Ana Henriques1,
  4. Helena Falcão4,
  5. Henrique Barros1,5,
  6. Sílvia Fraga1,5
  1. 1 EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
  2. 2 Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
  3. 3 Population Epidemiology Unit, Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
  4. 4 Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
  5. 5 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
  1. Correspondence to Sílvia Fraga, EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto 4050-600, Portugal; silfraga{at}


Objective This study aims to investigate the association of life-course socioeconomic status (SES) with lung function during adulthood, by exploring the influence of life-course social mobility and of cumulative exposure to low SES.

Methods Participants were 1458 individuals from EPIPorto study, a population-based cohort of Portuguese adults. The life-course SES was computed using participants’ paternal occupation and own occupation, resulting in four patterns: stable high, upward, downward, stable low. A cumulative life-course SES index was also calculated using the participants’ paternal occupation, own education and occupation. Lung function during adulthood was assessed with forced expiratory volume in first second (FEV1) and forced vital capacity (FVC) percentages predicted (higher percentages are associated with better lung function). Linear regression models were used to estimate beta coefficients and 95% CI for the association of socioeconomic indicators and lung function.

Results Disadvantaged SES from childhood to adulthood was associated with lower lung function (FEV1:−6.64%,−10.68;−2.60/FVC:−3.77%,−7.45;−0.08), and the greater the socioeconomic disadvantage, the lower the lung function (FEV1:−2.56%,−3.98;−1.15/FVC:−1.54%,−2.83;−0.24) among men, independently of marital status and behavioural factors. Among women, SES effects were only observed in those experiencing a stable low life-course SES at older ages (−5.15%,−10.20;−0.09). Men experiencing a downward social mobility presented the lowest lung function, but there was attenuation to the null after accounting for marital status and behavioural factors.

Conclusion A life-course disadvantaged SES is an important predictor of lower lung function during adulthood. Downward social mobility was associated with the lowest lung function among men, although this association was mostly explained by behavioural factors.

  • cohort studies
  • social and life-course epidemiology
  • health inequalities

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  • Contributors VR performed the study conceptualisation, conducted data analysis and interpretation, and drafted the manuscript. SS contributed to data analysis and interpretation and critically reviewed the manuscript. AH and HF contributed to data collection and critically reviewed the manuscript. HB conducted and supervised the cohort study and critically reviewed the manuscript. SF performed the study conceptualisation, contributed to data analysis and interpretation, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This work was supported by FEDER through the Operational Programme Competitiveness and Internationalisation and national funding from the Foundation for Science and Technology (FCT; Portuguese Ministry of Science, Technology and Higher Education) under the EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Portugal (POCI-01-0145-FEDER-006862; reference: UID/DTP/04750/2019) and within the projects ‘How childhood social adversity shapes health: The biology of social adversity’ (POCI-01-0145-FEDER-016838; reference: PTDC/DTP-EPI/1687/2014); ‘When do health inequalities start? Understanding the impact of childhood social adversity on health trajectories from birth to early adolescence’ (POCI-01-0145-FEDER-029567; reference: PTDC/SAU-PUB/29567/2017); and DOCnet (NORTE-01-0145-FEDER-000003), supported by the Regional Operational Programme for the Northern Region (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund. It is also supported by the European Commission through the Lifepath Consortium (Horizon 2020 grant no 633666), the PhD grant SFRH/BD/103726/2014 (VR) co-funded by FCT and the Human Capital Operational Program/European Social Fund, and the FCT contracts CEECIND/01793/2017/CP1406/CT0002 (AH) and CEECIND/01516/2017/CP1406/CT0001 (SF).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Ethics Committee of the Porto Medical School of Hospital São João (Approval number: CE HSJ n°65-20/10/95).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.