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Peer-reviewedCC BY 4.0JAMA Network Open

Neighborhood Social Disadvantage and Lung Aging and Mortality

  • Qizhen Wu1
  • Yanhong Huang2
  • Maria A. Picchi3
  • Elizabeth Y. Jimenez4
  • Yue Feng1
  • Steven A. Belinsky3
  • Yan Lin5,6
  • Vernon S. Pankratz1,7
  • Akshay Sood7
  • Roberta P. Lavin8
  • Xi Gong2,9
  • Shuguang Leng1,7
9 affiliations
  1. 1Comprehensive Cancer Center, University of New Mexico, Albuquerque
  2. 2Department of Biobehavioral Health, Pennsylvania State University, University Park
  3. 3Lung Cancer Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico
  4. 4College of Population Health, University of New Mexico Health Sciences Center, Albuquerque
  5. 5Department of Geography, Pennsylvania State University, University Park
  6. 6Social Science Research Institute, Pennsylvania State University, University Park
  7. 7Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque
  8. 8College of Nursing, University of New Mexico, Albuquerque
  9. 9Institute for Computational and Data Sciences, Pennsylvania State University, University Park
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{wu2026neighborhood,
  title = {{Neighborhood Social Disadvantage and Lung Aging and Mortality}},
  author = {Qizhen Wu and Yanhong Huang and Maria A. Picchi and Elizabeth Y. Jimenez and Yue Feng and Steven A. Belinsky and Yan Lin and Vernon S. Pankratz and Akshay Sood and Roberta P. Lavin and Xi Gong and Shuguang Leng},
  journal = {JAMA Network Open},
  year = {2026},
  month = nov,
  doi = {10.1001/jamanetworkopen.2026.42912},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856344},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Neighborhood Social Disadvantage and Lung Aging and Mortality
AU  - Qizhen Wu
AU  - Yanhong Huang
AU  - Maria A. Picchi
AU  - Elizabeth Y. Jimenez
AU  - Yue Feng
AU  - Steven A. Belinsky
AU  - Yan Lin
AU  - Vernon S. Pankratz
AU  - Akshay Sood
AU  - Roberta P. Lavin
AU  - Xi Gong
AU  - Shuguang Leng
PY  - 2026
DA  - 2026/11/09
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.42912
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856344
AB  - 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.
SN  - 2574-3805
ER  -