Thorax 66:1058-1064 doi:10.1136/thoraxjnl-2011-200621
  • Epidemiology
  • Original article

Longitudinal associations of socioeconomic position in childhood and adulthood with decline in lung function over 20 years: results from a population-based cohort of British men

  1. S G Wannamethee1
  1. 1Department of Primary Care and Population Health, UCL, London, UK
  2. 2Division of Population Health Sciences and Education, St George's University of London, London, UK
  1. Correspondence to Dr Sheena E Ramsay, Department of Primary Care and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK; s.ramsay{at}
  1. Contributors SER, PHW, RWM, SGW developed the original idea for the paper, and SER wrote the first draft. SER performed the analyses. PHW, LTL, RWM and SGW contributed to the design and execution of the British Regional Heart Study. All authors contributed to interpretation of data and the final version of the manuscript, and all are guarantors.

  • Received 15 November 2010
  • Accepted 30 June 2011
  • Published Online First 22 July 2011


Background Associations of socioeconomic position with lung function are reported mostly from cross-sectional studies. The aim of this study was to investigate the associations between socioeconomic position both in adulthood and childhood with changes in lung function over a 20-year period.

Methods A socioeconomically representative cohort of 7735 British men aged 40–59 years was followed-up from 1978–1980 to 1998–2000. Lung function (height-standardised forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)) was assessed at both time points in 4252 survivors. Adult socioeconomic position was derived from longest-held occupation in middle age and childhood socioeconomic position from father's longest-held occupation.

Results Both FEV1 and FVC declined over time; the decline increased progressively from social class I (highest) to V (lowest); p for trend ≤0.0001. The mean difference in decline comparing manual versus non-manual groups was −0.13 litres (95% CI −0.16 to −0.10) for FEV1 and −0.09 litres (95% CI −0.13 to −0.05) for FVC. These differences remained after adjustment for age, cigarette smoking, body mass index, physical activity and history of bronchitis. Similar differences in lung function decline were observed comparing manual with non-manual childhood social classes, although the differences were reduced by adjustment for adult social class and risk factors. Men in manual social classes in both childhood and adulthood had the greatest decline in lung function compared to those in non-manual groups in childhood and adulthood.

Conclusions Socioeconomic position across the life course could have a significant impact on decline in lung function in later life. The role of environmental factors associated with socioeconomic position merits further exploration.


  • Funding The British Regional Heart Study is a British Heart Foundation Research Group. The views expressed in this publication are those of the authors and not necessarily those of the funding body.

  • Competing interests None to declare.

  • Ethics approval This study was conducted with the approval of Multicentre Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.