Environmental equity, air quality, socioeconomic status, and respiratory health: a linkage analysis of routine data from the Health Survey for England.
OBJECTIVE
To assess relations between socioeconomic status and local air quality, and combined effects on respiratory health, in the context of environmental and health inequality.


METHODS
Data on people taking part in the Health Survey for England were attributed with a small area index of air pollution using annual mean concentrations of nitrogen dioxide, sulphur dioxide, benzene, and particulates (PM10). Regression models were used to measure associations between social class, air quality, forced expiratory volume in one second (FEV1), and self reported asthma.


METHODS
Participants aged 16-79 in the Health Survey for England 1995, 1996, and 1997.


RESULTS
Urban lower social class households were more likely to be located in areas of poor air quality, but the association in rural areas was, if anything reversed. Low social class and poor air quality were independently associated with decreased lung function (FEV1), but not asthma prevalence, after adjustment for a number of potential confounders. Social class effects were not attenuated by adjustment for air quality. In men, a differential effect of air pollution on FEV1 was found, with its effect in social classes III to V about double that in social classes I and II (p value for interaction = 0.04). This effect modification was not seen for women.


CONCLUSIONS
Further evidence of environmental inequity in the UK is provided. The association between FEV1 and local air quality is of similar magnitude to that with social class, and the adverse effects of air pollution seem to be greater in men in lower social classes.
Wheeler
Benedict W
BW
Department of Geography, University of Sheffield, Sheffield S10 2TN, UK. b.w.wheeler@sheffield.ac.uk
Ben-Shlomo
Yoav
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D004739:England / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D000393:Air Pollutants