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Socioeconomic status, whether measured by education, income, or other indices of social class, has long been known to be associated with mortality from different diseases.1-7 This knowledge for the major part stems from studies conducted in the UK where there is a tradition of interest in socioeconomic differences. A milestone within recent years was the “Black Report” prepared by a committee appointed by the UK Minister of Health in 1980.7 This report showed that there were still large socioeconomic differences in morbidity and mortality in men and women of all ages in England. Since then a number of epidemiological studies have been published, both in England and other European and North American countries, which confirm this relationship.8-12
Socioeconomic differences have been shown to exist for a number of diseases including ischaemic heart disease, many types of cancer, respiratory diseases and, in particular, mortality related to alcohol and violence. In addition, despite a general fall in mortality during recent decades, the relative disadvantage of low socioeconomic status continues to increase.3 7 The number of papers published on socioeconomic factors and morbidity and mortality is increasing sharply.13 The social gradient in ischaemic heart disease has been extensively studied but, although there are indicators that socioeconomic differences in respiratory diseases are greater still,2 very few studies have focused on this disease entity.
Review of current literature
A social class gradient in the prevalence of respiratory symptoms in adults, in particular cough and sputum, was first observed in early studies in the UK.1 This has later been confirmed in other studies, most of which date from the 1970s.2 14-26 The relationship between socioeconomic factors and symptoms, lung function parameters, and respiratory morbidity in studies in adults is summarised in table 1. Most of these studies have adjusted for smoking …
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