Disparities in Pulmonary Function in Healthy Children across the Indian Urban-Rural Continuum

Rationale: Marked socioeconomic health-care disparities are recognized in India, but lung health inequalities between urban and rural children have not been studied. Objectives: We investigated whether differences exist in spirometric pulmonary function in healthy children across the Indian urban-rural continuum and compared results with those from Indian children living in the UK. Methods: Indian children aged 5 to 12 years were recruited from Indian urban, semiurban, and rural schools, and as part of the Size and Lung Function in Children study, London. Anthropometric and spirometric assessments were undertaken. Measurements and Main Results: Acceptable spirometric data were obtained from 728 (58% boys) children in India and 311(50% boys) UK-Indian children. As an entire group, the India-resident children had significantly lower z FEV1 and z PVC than UK-Indian children (P < 0.0005), when expressed using Global Lung Function Initiative-2012 equations. However, when India-resident children were categorized according to residence, there were no differences in z FEV1 and z PVC between Indian-urban and UK-Indian children. There were, however, significant reductions of similar to 0.5 z scores and 0.9 z scores in both FEV1 and PVC (with no difference in FEV1/FVC) in Indian-semiurban and Indian-rural children, respectively, when compared with Indian-urban children (P < 0.0005). z Body mass index, socioeconomic circumstances, tobacco, and biomass exposure were individually significantly associated with z FEV1 and z PVC (P < 0.0005). Conclusions: The presence of an urban-rural continuum of lung function within a specific ethnic group emphasizes the impact of environmental factors on lung growth in emerging nations such as India, which must be taken into account when developing ethnic-specific reference values or designing studies to optimize lung health.