Social Determinants of Health and Racial Disparities in Lung Function: Findings from the National Health and Nutrition Examination Survey, 2007–2012

Amin Adibi, Christopher Carlsten, Emily P. Brigham, Don D. Sin, Peter Loewen, Mohsen Sadatsafavi

Abstract: Rationale: We hypothesized that the disproportionate impact of social determinants of health (SDoH) captured in survey data could help explain a larger proportion of racial gaps in lung function than previously reported. Objective: To estimate the contribution of SDoH to racial gaps in lung function. Methods: We defined a series of nested, increasingly healthy reference populations using data from the National Health and Nutrition Examination Survey, 2007–2012. Starting with nonsmokers without respiratory symptoms or diagnoses, we sequentially excluded those with confirmed occupational exposure to dust and/or fumes, physical inactivity, maternal or secondhand tobacco use, obesity, no home ownership, no insurance, lower education, and self-reported unhealthy diet. Across successive populations, we compared average age-, sex-, and height-adjusted differences in FEV1 and FVC between racial and ethnic minority groups and non-Hispanic White participants for adults (aged ⩾20 yr) and children (aged 6–19 yr). Measurements and Main Results: In successively healthier reference populations, the proportion of represented participants declined for non-Hispanic Black, Mexican American, and other Hispanic participants; increased for non-Hispanic White participants; and remained stable for non-Hispanic Asian participants. At baseline, adjusted FEV1 and FVC were similar for Mexican American and non-Hispanic White American participants but lower for other racial and ethnic minority groups. After excluding individuals with unfavorable SDoH, racial disparities in FEV1 and FVC decreased for non-Hispanic Black children (24.8% and 26.2%) and adults (26.3% and 19.4%), other Hispanic children (15.2% and 19.3%) and adults (85.9% and 12.4%), and non-Hispanic Asian children (6.6% and 12.5%), but they increased for non-Hispanic Asian adults (14.1% and 11.1%). Conclusions: Unfavorable SDoH disproportionately affected non-Hispanic Black, Mexican American, and other Hispanic populations and explained a higher proportion of racial disparities in lung function than previously reported.

External IDs:doi:10.1164/rccm.202501-0280oc