title: Socioeconomic status is associated with reduced lung function in China: an analysis from a large cross-sectional study in Shanghai.
abstract: BACKGROUND
  An inverse association between socioeconomic status and pulmonary function has emerged in many studies. However, the mediating factors in this relationship are poorly understood, and might be expected to differ between countries. We sought to investigate the relationship between socioeconomic status and lung function in China, a rapidly industrializing nation with unique environmental challenges, and to identify potentially-modifiable environmental mediators.
  
  
  METHODS
  We used data from the Shanghai Putuo Study, a cross-sectional study performed in Shanghai, China. Participants completed a questionnaire and spirometry. The primary exposure was socioeconomic status, determined by education level. The primary outcomes were FEV1 and FVC percent predicted. Multiple linear regressions were used to test this association, and the percent explained by behavioral, environmental, occupational, and dietary variables was determined by adding these variables to a base model.
  
  
  RESULTS
  The study population consisted of a total of 22,878 study subjects that were 53.3 % female and had a mean age of 48. In the final multivariate analysis, the effect estimates for FEV1 and FVC percent predicted for low socioeconomic status (compared to high) were statistically significant at a p-value of <0.01. Smoking, biomass exposure, mode of transportation to work, a diet low in fruits or vegetables, and occupational category partially attenuated the relationship between SES and lung function. In a fully-adjusted age-stratified analysis, the socioeconomic disparity in lung function widened with increasing age.
  
  
  CONCLUSIONS
  We found cross-sectional evidence of socioeconomic disparities in pulmonary function in Shanghai. These differences increased with age and were partially explained by potentially modifiable exposures.
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. agaffney@mgh.harvard.edu.
authors.forename: Adam W
authors.initials: AW
authors.lastname: Gaffney
authors.affiliation: Shanghai Putuo District People's Hospital, Shanghai, China. hangjq@hotmail.com.
authors.forename: Jing-qing
authors.initials: JQ
authors.lastname: Hang
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. mslee@hsph.harvard.edu.
authors.forename: Mi-Sun
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. lisu@hsph.harvard.edu.
authors.forename: Li
authors.initials: L
authors.lastname: Su
authors.affiliation: Shanghai Putuo District People's Hospital, Shanghai, China. zhangfy74@sina.com.
authors.forename: Feng-ying
authors.initials: FY
authors.lastname: Zhang
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. dchris@hsph.harvard.edu.|Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. dchris@hsph.harvard.edu.|Harvard Medical School, Boston, MA, USA. dchris@hsph.harvard.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012923:Social Class; D012959:Socioeconomic Factors; D013147:Spirometry / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*
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