title: Disparities in pulmonary function in healthy children across the Indian urban-rural continuum.
abstract: BACKGROUND
  Marked socioeconomic health-care disparities are recognized in India, but lung health inequalities between urban and rural children have not been studied.
  
  
  OBJECTIVE
  We investigated whether differences exist in spirometric pulmonary function in healthy children across the Indian urban-rural continuum and compared results with those from Indian children living in the UK.
  
  
  METHODS
  Indian children aged 5 to 12 years were recruited from Indian urban, semiurban, and rural schools, and as part of the Size and Lung Function in Children study, London. Anthropometric and spirometric assessments were undertaken.
  
  
  RESULTS
  Acceptable spirometric data were obtained from 728 (58% boys) children in India and 311 (50% boys) UK-Indian children. As an entire group, the India-resident children had significantly lower z FEV1 and z FVC than UK-Indian children (P < 0.0005), when expressed using Global Lung Function Initiative-2012 equations. However, when India-resident children were categorized according to residence, there were no differences in z FEV1 and z FVC between Indian-urban and UK-Indian children. There were, however, significant reductions of ∼ 0.5 z scores and 0.9 z scores in both FEV1 and FVC (with no difference in FEV1/FVC) in Indian-semiurban and Indian-rural children, respectively, when compared with Indian-urban children (P < 0.0005). z Body mass index, socioeconomic circumstances, tobacco, and biomass exposure were individually significantly associated with z FEV1 and z FVC (P < 0.0005).
  
  
  CONCLUSIONS
  The presence of an urban-rural continuum of lung function within a specific ethnic group emphasizes the impact of environmental factors on lung growth in emerging nations such as India, which must be taken into account when developing ethnic-specific reference values or designing studies to optimize lung health.
authors.affiliation: 1 Respiratory, Critical Care, and Anaesthesia Section (Portex Unit) and.
authors.forename: Samatha
authors.initials: S
authors.lastname: Sonnappa
authors.forename: Sooky
authors.initials: S
authors.lastname: Lum
authors.forename: Jane
authors.initials: J
authors.lastname: Kirkby
authors.forename: Rachel
authors.initials: R
authors.lastname: Bonner
authors.forename: Angela
authors.initials: A
authors.lastname: Wade
authors.forename: Vinita
authors.initials: V
authors.lastname: Subramanya
authors.forename: Padmanabha T
authors.initials: PT
authors.lastname: Lakshman
authors.forename: Babitha
authors.initials: B
authors.lastname: Rajan
authors.forename: Shalini C
authors.initials: SC
authors.lastname: Nooyi
authors.forename: Janet
authors.initials: J
authors.lastname: Stocks
mesh_terms: D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D005541:Forced Expiratory Volume; D054624:Health Status Disparities; D006801:Humans; D007194:India / Q000453:epidemiology; D008168:Lung / Q000502:physiology*; D008297:Male; D009752:Nutritional Status / Q000208:ethnology / Q000502:physiology*; D012129:Respiratory Function Tests; D012143:Respiratory Physiological Phenomena; D012423:Rural Health / Q000208:ethnology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013147:Spirometry; D006113:United Kingdom / Q000208:ethnology; D014504:Urban Health / Q000208:ethnology / Q000706:statistics & numerical data; D014797:Vital Capacity
keywords: children; ethnic differences in lung function; rural; socioeconomic circumstances; urban