Influence of Socio-Economic Status on Lung Function in Male Adolescents in Tanzania

  • Ewa Rębacz-MaronEmail author
  • Anna Stangret
  • Iwona Teul
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1150)


A lower socio-economic status (SES) associates with increased morbidity and mortality. The goal of this study was to define the influence of SES on lung function in indigenous male adolescents (aged 12.8–24.5 years) in Tanzania. The subjects were subdivided into two age groups: <17.5 (n = 189) and ≥ 17.5 years of age (n = 101). They underwent anthropometric and spirometry evaluation. The SES was assessed on the basis of economic family resources and the subjects’ nutritional status, and was stratified into three categories: SES-1 (low), SES-2 (average), and SES-3 (high). Relative contributions of body mass index, chest expansion/mobility, waist-to-chest ratio, and SES to spirometry variables were statistically determined. We found significant differences in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) in the older, but not younger age group, by the SES category. The adolescents aged ≥17.5 in high-SES-3 category had FEV1 and FVC greater by 29.3% and 42.5%, respectively, than those in low-SES-1 category in the same age group. There also were differences between the two age groups. The mean FEV1 and FVC in adolescents of high-SES-3 category, aged ≥17.5, were higher by 65.3% and 82.2%, respectively, than those in the corresponding SES-3 in adolescents aged <17.5. In younger adolescents, lung function variables associated mostly with body build parameters, whereas in older adolescents with SES. The study revealed a significant dependence of lung function, and thus plausibly a greater resistance to diseases, on the socio-economic status. We conclude that the socio-economic status be taken into consideration in the assessment of lung function in epidemiological and public health programs, particularly in the context of the developing countries, to obtain the most reliable results.


Adolescents Anthropometry Environmental factors Lung function Socioeconomic status Spirometry 



Our thanks go to the young people from Tanzania who participated in this research. We also wish to thank the principals of local schools at which the research was conducted for their eagerness to cooperate.

Conflicts of Interest

The authors declare no conflicts of interest in relation to this study.


  1. Adler NE, Boyce T, Chesney MA, Cohen S, Folkman S, Kahn RL, Syme SL (1994) Socio–economic status and health: the challenge of the gradient. Am Psychol 49(1):15–24CrossRefGoogle Scholar
  2. Asad AL, Clair M (2017) Racialized legal status as a social determinant of health. Soc Sci Med 199:19–28CrossRefGoogle Scholar
  3. Balte P, Karmaus W, Roberts G, Kurukulaaratchy R, Mitchell F, Arshad SH (2016) Relationship between birth weight, maternal smoking during pregnancy and childhood and adolescent lung function: a path analysis. Respir Med 121:13–20CrossRefGoogle Scholar
  4. Basagaña X, Sunyer J, Kogevinas M, Zock JP, Duran–Tauleria E, Jarvis D, Burney P, Anto JM (2004) Socio–economic status and asthma prevalence in young adults: the European community respiratory health survey. Am J Epidemiol 160(2):178–188CrossRefGoogle Scholar
  5. Belbasis L, Savvidou MD, Kanu C, Evangelou E, Tzoulaki I (2016) Birth weight in relation to health and disease in later life: an umbrella review of systematic reviews and meta–analyses. BMC Med 14:147CrossRefGoogle Scholar
  6. Bolte G, Tamburlini G, Kohlhuber M (2010) Environmental inequalities among children in Europe–evaluation of scientific evidence and policy implications. Eur J Pub Health 20(1):14–20CrossRefGoogle Scholar
  7. Boroń S (1982) Development of body dimensions and proportions in male adolescents from Sandoa in Zair. Anthropologic Materials and Works. No. 102, Wrocław, Poland (Article in Polish)Google Scholar
  8. Brunekreef B, Janssen NA, de Hartog J, Harssema H, Knape M, van Vliet P (1997) Air pollution from truck traffic and lung function in children living near motorways. Epidemiology 8:298–303CrossRefGoogle Scholar
  9. Burchard EG, Ziv E, Coyle N, Gomez SL, Tang H, Karter AJ, Mountain JL, Pérez–Stable EJ, Sheppard D, Risch N (2003) The importance of race and ethnic background in biomedical research and clinical practice. N Engl J Med 348(12):1170–1175CrossRefGoogle Scholar
  10. Cakmak S, Hebbern C, Cakmak JD, Vanos J (2016) The modifying effect of socio–economic status on the relationship between traffic, air pollution and respiratory health in elementary schoolchildren. J Environ Manag 177.(Supplement C:1–8CrossRefGoogle Scholar
  11. Chikakuda AT, Song S, Song WO (2017) Frequency of antenatal care visit is a key modifiable determinant of low birth weight in Malawi. FASEB J 31(1 Suppl): Abstract 958.25Google Scholar
  12. de Cordoba Lanza F, de Camargo AA, Archija LRF, Selman JPR, Malaguti C, Dal Corso S (2013) Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respir Care 58(12):2107–2112CrossRefGoogle Scholar
  13. Dufetel P, Sambiani K, Togbey K, Kolani M (1990) Characteristics of lung volume and expiratory flow seen in black Africans adults. Rev Mal Respir 7(3):215–222PubMedGoogle Scholar
  14. Enright SJ, Unnithan VB (2011) Effect of inspiratory muscle training intensities on pulmonary function and work capacity in people who are healthy: a randomized controlled trial. Phys Ther 91(6):894–905CrossRefGoogle Scholar
  15. Eveleth PB (1978) Differences between populations in body shape of children and adolescents. Am J Phys Anthropol 49(3):373–381CrossRefGoogle Scholar
  16. Fabian KM (2010) Evaluation of lung function, chest mobility, and physical fitness during rehabilitation of scoliotic girls. Ortop Traumatol Rehabil 12(4):301–309PubMedGoogle Scholar
  17. Gauderman WJ, Vora H, McConnell R, Berhane K, Gilliland F, Thomas D, Lurmann F, Avol E, Kunzli N, Jerrett M (2007) Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet 369(9561):571–577CrossRefGoogle Scholar
  18. Gray LA, Leyland AH, Benzeval M, Watt GC (2013) Explaining the social patterning of lung function in adulthood at different ages: the roles of childhood precursors, health behaviours and environmental factors. J Epidemiol Community Health 67(11):905–911CrossRefGoogle Scholar
  19. Hancox RJ, Poulton R, Greene JM, McLachlan CR, Pearce MS, Sears M (2009) Associations between birth weight, early childhood weight gain, and adult lung function. Thorax 64:228–232CrossRefGoogle Scholar
  20. Harik–Khan RI, Fleg JL, Muller DC, Wise RA (2001) The effect of anthropometric and socio–economic factors on the racial difference in lung function. Am J Respir Crit Care Med 164(9):1647–1654CrossRefGoogle Scholar
  21. Harik–Khan RI, Muller DC, Wise RA (2004) Racial difference in lung function in African–American and White children: effect of anthropometric, socio–economic, nutritional, and environmental factors. Am J Epidemiol 160(9):893–900CrossRefGoogle Scholar
  22. Hegewald MJ, Crapo RO (2007) Socio–economic status and lung function. Chest 132(5):1608–1614CrossRefGoogle Scholar
  23. Isaacs SL, Schroeder SA (2004) Class – the ignored determinant of the nation’s health. N Engl J Med 351(11):1137–1142CrossRefGoogle Scholar
  24. Katzmarzyk PT, Leonard WR (1998) Climatic influences on human body size and proportions: ecological adaptations and secular trends. Am J Phys Anthropol 106(4):483–503CrossRefGoogle Scholar
  25. Kennedy BP, Kawachi I, Glass R, Prothrow–Stith D (1998) Income distribution, socio–economic status, and self–rated health in the United States: multilevel analysis. BMJ 317:917–921CrossRefGoogle Scholar
  26. Lawlor D, Ebrahim S, Davey S (2005) Association of birth weight with adult lung function: findings from the British Women’s Heart and Health Study and a meta–analysis. Thorax 60(10):851–858CrossRefGoogle Scholar
  27. Ma YN, Wang J, Dong GH, Liu MM, Wang D, Liu YQ, Zhao Y, Ren WH, Lee YL, Zhao YD (2013) Predictive equations using regression analysis of pulmonary function for healthy children in Northeast China. PLoS One 8(5):e63875CrossRefGoogle Scholar
  28. Marmot M (2005) Social determinants of health inequalities. Lancet 365(9464):1099–1104CrossRefGoogle Scholar
  29. Martin R, Saller K (1958) Lehrbuch der Anthropologie in Systematischer Darstellung. Gustav Fischer Verlag, Stuttgart (Book in German)Google Scholar
  30. Moshammer H, Hoek G, Luttmann–Gibson H, Neuberger MA, Antova T, Gehring U, Hruba F, Pattenden S, Rudnai P, Slachtova H (2006) Parental smoking and lung function in children: an international study. Am J Respir Crit Care Med 173(11):1255–1263CrossRefGoogle Scholar
  31. Mukhopadhyay S, Macleod K, Ong T, Ogston S (2001) Ethnic variation in childhood lung function may relate to preventable nutritional deficiency. Acta Paediatr 90(11):1299–1303CrossRefGoogle Scholar
  32. Ong TJ, Mehta A, Ogston S, Mukhopadhyay S (1998) Prediction of lung function in the inadequately nourished. Arch Dis Child 79(1):18–21CrossRefGoogle Scholar
  33. Physical status (1995) The use and interpretation of anthropometry. Report of a WHO expert committee. WHO Tech Rep Ser Geneva 854:1–452Google Scholar
  34. Prescott E, Vestbo J (1999) Socio–economic status and chronic obstructive pulmonary disease. Thorax 54(8):737–741CrossRefGoogle Scholar
  35. Rębacz–Maron E (2018) The multiethnic global lung initiative 2012 and Third National Health and Nutrition Examination Survey reference values do not reflect spirometric measurements in Black boys and men from Tanzania. Clin Physiol Funct Imaging 38(1):76–86CrossRefGoogle Scholar
  36. Saad HB, Prefaut C, Missaoui R, Mohamed IH, Tabka Z, Hayot M (2009) Reference equation for 6–min walk distance in healthy North African children 6–16 years old. Pediatr Pulmonol 44(4):316–324CrossRefGoogle Scholar
  37. Sahni S, Talwar A, Khanijo S, Talwar A (2017) Socio–economic status and its relationship to chronic respiratory disease. Adv Respir Med 85(2):97–108CrossRefGoogle Scholar
  38. Sastre SF (2006) Método de tratamiento de las escoliosis, cifosis y lordosis. 2nd edn. Edicions, Universitat Barcelona. ISBN: 8447530434 (Book in Spanish)Google Scholar
  39. Shohaimi S, Welch A, Bingham S, Luben R, Day N, Wareham N, Khaw KT (2004) Area deprivation predicts lung function independently of education and social class. Eur Respir J 24(1):157–161CrossRefGoogle Scholar
  40. Silventoinen K (2003) Determinants of variation in adult body height. J Biosoc Sci 35(2):263–285CrossRefGoogle Scholar
  41. Stanojevic S, Wade A, Stocks J (2010) Reference values for lung function: past, present and future. Eur Respir J 36(1):12–19CrossRefGoogle Scholar
  42. Stein C, Kumaran K, Fall C, Shaheen S, Osmond C, Barker D (1997) Relation of fetal growth to adult lung function in South India. Thorax 52(10):895–899CrossRefGoogle Scholar
  43. Tabak C, Spijkerman A, Verschuren W, Smit H (2009) Does educational level influence lung function decline (Doetinchem Cohort Study)? Eur Respir J 34(4):940–947CrossRefGoogle Scholar
  44. Tahirović HF (1998) Menarchal age and the stress of war: an example from Bosnia. Eur J Pediatr 157:978–980CrossRefGoogle Scholar
  45. Torres LA, Martinez FE, Manco JC (2003) Correlation between standing height, sitting height, and arm span as an index of pulmonary function in 6–10–year–old children. Pediatr Pulmonol 36(3):202–208CrossRefGoogle Scholar
  46. Tyrrell J, Jones SE, Beaumont R, Astley CM, Lovell R, Yaghootkar H, Tuke M, Ruth KS, Freathy RM, Hirschhorn JN, Wood AR, Murray A, Weedon MN, Frayling TM (2016) Height, body mass index, and socioeconomic status: mendelian randomisation study in UK Biobank. BMJ 352:i582CrossRefGoogle Scholar
  47. Wang X, Dockery DW, Wypij D, Fay ME, Ferris BG Jr (1993) Pulmonary function between 6 and 18 years of age. Pediatr Pulmonol 15(2):75–88CrossRefGoogle Scholar
  48. Weedon MN, Lango H, Lindgren CM, Wallace C, Evans DM, Mangino M et al (2008) Genome–wide association analysis identifies 20 loci that influence adult height. Nat Genet 40(5):575–583CrossRefGoogle Scholar
  49. Welle I, Eide GE, Gulsvik A, Bakke PS (2004) Pulmonary gas exchange and educational level: a community study. Eur Respir J 23(4):583–588CrossRefGoogle Scholar
  50. Wheeler BW, Ben–Shlomo Y (2005) Environmental equity, air quality, socio–economic status, and respiratory health: a linkage analysis of routine data from the Health Survey for England. J Epidemiol Community Health 59:948–954CrossRefGoogle Scholar
  51. Whittaker AL, Sutton AJ, Beardsmore CS (2005) Are ethnic differences in lung function explained by chest size? Arch Dis Child Fetal Neonatal Ed 90(5):F423–F428CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG  2018

Authors and Affiliations

  1. 1.Faculty of Biology, Department of Vertebrate Zoology and Anthropology, Institute for Research on Biodiversity, Faculty of BiologyUniversity of SzczecinSzczecinPoland
  2. 2.Department of General and Clinical AnatomyPomeranian Medical UniversitySzczecinPoland

Personalised recommendations