Children’s Lung Function Was Lower in 2017–2018than in 1995–1996: The Roles of Air Quality Change and Individual-LevelRisk Factors

Air quality has improved while the lifestyle of children has changed substantially over the past 2 decades in four Chinese cities. It is unknown how these changes affected the lung function of children. We analyzed data collected in 1995–1996 and 2017–2018. In each period, >2000 children 6–13 years were measured for lung function and surveyed for behavioral, residential, and health conditions. Monitored and modeled data for ambient air pollution were obtained. Age- and covariate-adjusted FVC and FEV₁ values were lower, and the proportions of children with low FVC and FEV₁ were greater in the later period than in the earlier period, while PM_2.5, PM₁₀, SO₂, NO_<i>x</i>, and O₃ levels changed by −42.8 μg/m³ (95% CI, −67.3, −18.6 mg/m³), −65.1 μg/m³ (−113.5, −16.7 mg/m³), −34.6 ppb (−69.2, 0.0 ppb), −27.5 ppb (−60.7, 5.7 ppb), and 1.5 ppb (−4.2, 7.1 ppb), respectively. A 4 ppb O₃ increase was associated with lower FVC by 105 mL (95% CI: 30, 180 mL) in boys and 76 mL (17, 135 mL) in girls. A generational decline in the lung function of children in the 4 Chinese cities has significant public health ramifications. Our findings imply that the reduction of ambient air pollutant concentrations from the 1995–1996 levels to the 2017–2018 levels were not sufficient to make lung function improvements. Risk factors that were absent or not as prominent in the earlier period may be responsible for lowered lung function during the later period.