American journal of respiratory and critical care medicineJournal Article
09 May 2025
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.
We defined a series of nested, increasingly healthy reference populations using data from NHANES 2007-2012. Starting with non-smokers without respiratory symptoms or diagnoses, we sequentially excluded those with confirmed occupational exposure to dust/fumes, physical inactivity, maternal or second-hand 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 (≥20) and children (6-19).
In successively healthier reference populations, the proportion of represented participants declined for Non-Hispanic Black, Mexican American, and Other Hispanic, increased for non-Hispanic White, and remained stable for Non-Hispanic Asian participants. At baseline, adjusted FEV1 and FVC were similar for Mexican Americans and non-Hispanic White Americans, 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 increased for Non-Hispanic Asian adults (14.1% and 11.1%).
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.
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