Schikowski Tamara, Sugiri Dorothee, Reimann Verena, Pesch Beate, Ranft Ulrich, Krämer Ursula
Institut für Umweltmedizinische Forschung (IUF) at the Heinrich-Heine-University of Düsseldorf, Auf'm Hennekamp 50, 40225 Düsseldorf, Germany.
BMC Public Health. 2008 May 27;8:179. doi: 10.1186/1471-2458-8-179.
Socio-economic status, smoking, and exposure to increased levels of environmental air pollution are associated with adverse effects on respiratory health. We assessed the contribution of occupational exposures, smoking and outdoor air pollution as competing factors for the association between socio-economic status and respiratory health indicators in a cohort of women from the Ruhr area aged 55 at the time of investigation between 1985 and 1990.
Data of 1251 women with spirometry and complete questionnaire information about respiratory diseases, smoking and potential confounders were used in the analyses. Exposure to large-scale air pollution was assessed with data from monitoring stations. Exposure to small-scale air pollution was assessed as traffic-related exposure by distance to the nearest major road. Socio-economic status was defined by educational level. Multiple regression models were used to estimate the contribution of occupational exposures, smoking and outdoor air pollution to social differences in respiratory health.
Women with less than 10 years of school education in comparison to more than 10 years of school education were more often occupationally exposed (16.4% vs. 10.1%), smoked more often (20.3% vs. 13.9%), and lived more often close to major roads (26.0% vs. 22.9%). Long-term exposure to increased levels of PM10 was significantly associated with lower school education. Women with low school education were more likely to suffer from respiratory symptoms and had reduced lung function. In the multivariate analysis the associations between education and respiratory health attenuated after adjusting for occupational exposure, smoking and outdoor air pollution. The crude odds ratio for the association between the lung function indicator FEV1 less than 80% of predicted value and educational level (<10 years vs. >10 years of school education) was 1.83 (95% CI: 1.22-2.74). This changed to 1.56 (95% CI: 1.03-2.37) after adjusting for occupational exposure, smoking and outdoor air pollution.
We found an association between socio-economic status and respiratory health. This can partly be explained by living conditions indicated by occupational exposure, smoking behaviour and ambient air pollution. A relevant part of the social differences in respiratory health, however, remained unexplained.
社会经济地位、吸烟以及暴露于环境空气污染水平的增加与对呼吸健康的不良影响相关。我们评估了职业暴露、吸烟和室外空气污染作为竞争因素，在1985年至1990年调查时年龄为55岁的鲁尔地区一组女性中，对社会经济地位与呼吸健康指标之间关联的贡献。
分析中使用了1251名女性的数据，这些女性有肺活量测定数据以及关于呼吸系统疾病、吸烟和潜在混杂因素的完整问卷信息。利用监测站的数据评估大规模空气污染暴露情况。将与小规模空气污染的暴露评估为与交通相关的暴露，依据到最近主要道路的距离来衡量。社会经济地位由教育水平界定。使用多元回归模型来估计职业暴露、吸烟和室外空气污染对呼吸健康社会差异的贡献。
与接受超过10年学校教育的女性相比，接受少于10年学校教育的女性职业暴露情况更常见（16.4%对10.1%），吸烟更频繁（20.3%对13.9%），且居住在靠近主要道路的地方更常见（26.0%对22.9%）。长期暴露于PM10水平升高与较低的学校教育显著相关。学校教育水平低的女性更易出现呼吸道症状且肺功能降低。在多变量分析中，调整职业暴露、吸烟和室外空气污染后，教育与呼吸健康之间的关联减弱。肺功能指标第一秒用力呼气容积（FEV1）低于预测值80%与教育水平（<10年对>10年学校教育）之间关联的粗比值比为1.83（95%可信区间：1.22 - 2.74）。调整职业暴露、吸烟和室外空气污染后，这一比值比变为1.56（95%可信区间：1.03 - 2.37）。
我们发现社会经济地位与呼吸健康之间存在关联。这部分可由职业暴露、吸烟行为和环境空气污染所表明的生活条件来解释。然而，呼吸健康方面社会差异的一个相关部分仍无法解释。
