Neighborhood Social Disadvantage and Lung Aging and Mortality

Importance Neighborhood social disadvantage (NSD) is increasingly recognized as being associated with health disparities. However, its associations with longitudinal lung function decline, health-related quality of life (HRQOL), and mortality remain incompletely understood. Objective To evaluate associations of NSD with lung function, HRQOL, and all-cause mortality and to explore potential mediators of any association. Design, Setting, and Participants Prospective cohort study of current and former smokers aged 40 to 75 years with at least 10 pack-years of smoking history in the Lovelace Smokers Cohort. Participants underwent repeated spirometry approximately every 18 months from 2001 through 2017. Mortality was ascertained through October 2020 using the National Death Index. Data were analyzed from January to May 2025. Exposures Census tract–level Social Vulnerability Index (SVI) and Social Deprivation Index (SDI) assigned to residential addresses. Main Outcomes and Measures Baseline and longitudinal lung function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and the FEV1:FVC ratio), baseline HRQOL assessed by the St George’s Respiratory Questionnaire (SGRQ), with higher scores indicating poorer respiratory health status, and the 36-item Short Form Survey, and all-cause mortality. Formal mediation analyses evaluated educational attainment, current smoking status, and dietary patterns, whereas baseline lung function and HRQOL were considered as potential mediators for associations of NSD with all-cause mortality. Results Among 2362 included participants, the mean (SD) baseline age was 56.3 (9.4) years, and 1738 (73.58%) were female. A 1-IQR increase in SDI was associated with lower baseline FEV1 (β, −0.09 [95% CI, −0.13 to −0.06] L) and FEV1:FVC ratio (β, −1.21 [95% CI, −1.80 to −0.62] percentage points). Higher SVI was associated with faster annual decline in FEV1 (β, −3.11 [95% CI, −5.86 to −0.36] mL/y) and FEV1:FVC ratio (β, −0.05 [95% CI, −0.11 to −0.001] percentage points/y), worse baseline HRQOL, including a higher SGRQ total score (β, 4.46 [95% CI, 3.26-5.65] points), and higher all-cause mortality (hazard ratio, 1.28 [95% CI, 1.08-1.53]). Current smoking status and 2 dietary pattern scores mediated 4.4% (95% CI, −1.2% to 12.8%) to 31.0% (95% CI, 13.0%-51.6%) and 4.5% (95% CI, 0.2%-12.9%) to 17.0% (95% CI, 5.5%-113.7%), respectively, of selected associations between NSD and lung health outcomes; baseline lung function and HRQOL mediated 6.7% (95% CI, 0.6%-22.8%) to 38.6% (95% CI, 19.9%-125.3%) of selected associations with all-cause mortality. Conclusions and Relevance In this cohort study, worse NSD was associated with faster lung function decline, worse HRQOL, and higher all-cause mortality among ever smokers. Mediation analyses suggested that current smoking status and dietary patterns may partially account for associations of NSD with lung function and HRQOL.