The rich breathe better than the poor

The first recognized appearance of smog occurred in the summer of 1943 in Los Angeles, which was experiencing a rapid boom in automotive development. Visibility was reduced to just three blocks, and the harmful substance in the air caused a burning sensation in the eyes and lungs.

The air quality in the United States deteriorated before improving. But eighty million Americans still live in counties where air pollution is unsanitary, the general trend has been downward since its peak circa 1970 through regulations aimed at reducing emissions.

During the same period, smoking rate hastily declined. Meanwhile, new workplace regulations aimed at indoor air quality. One would think, given both improved outdoor and indoor air quality and decreased smoking, that lung health trends in the United States would be dramatically upward. But the benefits of this trend have not been evenly distributed.

While overall lung function has improved, disparities in lung health have persisted or increased over the past six decades, a reality that has impacted health outcomes during the COVID-19 pandemic.

Since COVID-19 is a respiratory disease, lung health has played a major role in determining the severity of cases. People with poorer lung health are at increased risk of hospitalization and death. And according to a new study titled “Socioeconomic Inequalities in Respiratory Health in the United States from 1959 to 2018” published in the journal JAMA Internal Medicine, class makes a bigger difference than before in determining lung health.

To study the issue of lung health disparities, researchers looked at six decades of data from national surveys. The surveys collected information on everything from habits to symptoms, and it was possible to break down the results by income and education.

In some cases, the survey data contained the results of actual lung function tests. Looking at these results, the researchers found that the gap between the lung function of rich and poor respondents has widened since 1971, a trend that may help explain economic disparities in the results of COVID-19.

Of course, smoking is a big part of the story. Researchers observe that before the 1980s, the class had little influence over who smoked and who did not. Over the following decades, smoking rates fell sharply among the richest Americans and did not change much among the poorest.

But smoking does not explain the whole phenomenon. In the late 1970s, the prevalence of childhood asthma was similar in the highest and lowest income groups. While asthma rates have increased in all income groups since then, they have increased fastest among the poorest. Today, the rate of childhood asthma in the lowest income quintile is double the rate of asthma in the highest quintile. Childhood asthma is strongly linked to environmental factors like pollution.

The same general pattern of lung disease applied to adults, where economic disparities in the incidence of chronic obstructive pulmonary disease (COPD) widened. COPD has been shown to be Positively correlated with increased risks of hospitalization, ICU admission and death from COVID-19. Some towns factors related to COPD include not only smoking, but exposure to unsanitary working conditions, polluted towns and neighborhoods, and inadequate access to health care.

Sifting through the survey data, the researchers found that no economic disparities in any measure of lung health had narrowed over the past six decades. They all either persisted or widened. Respondents to these surveys were asked to self-report shortness of breath on exertion, problematic cough, and wheezing. Even when the overall incidence of these problems has declined, disparities in income and education have widened.

“Poorer, less educated Americans are not enjoying the fruits of progress,” says study co-author Steffie Woolhandler, primary care physician and distinguished professor at Hunter College at CUNY and senior lecturer at Harvard Medical School.

“They continue to work in dangerous workplaces, live in polluted neighborhoods and have less access to health care. Until we address these inequalities, inequalities in lung health will persist. “

Lead author of the study, Adam Gaffney, assistant professor of medicine at Harvard Medical School and pulmonary and critical care specialist at Cambridge Health Alliance, points out that the growing economic disparity in lung health has paved the way for the devastation caused by the COVID-19 pandemic.

“We have learned from the COVID-19 pandemic that the inequalities in our society are reflected in the health of our lungs,” says Gaffney. “Our study shows that inequalities in lung health – which have made many people vulnerable to COVID-19 pneumonia – are long-standing and growing. “

“To right this injustice,” adds Gaffney, “we need to make sure that everyone has the prerequisites for healthy lungs: clean air to breathe, a safe and hygienic workplace, and high quality health care. . “

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