The mediating role of air pollutants in the association between education and lung function among the elderly, the HAPIEE study.

Background: Chronic exposure to air pollutants harms human health, and at a geographical level, concentrations of air pollutants are often associated with socioeconomic disadvantage.

Objectives: The aim of this study was to investigate the effects of educational attainment and air pollution on lung function in older adults, and whether air pollution may mediate the effect of education.

Methods: The study included 6381 individuals (mean age 58.24 ± 7.14 years) who participated in the Czech HAPPIE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study. Participants' residential addresses were linked to air pollution data, including mean exposures to PM (particulate matter of aerodynamic diameter below 10 μm) and NO (nitrogen dioxide). We used path analysis to link educational attainment and air pollutants to a standardized measure of the Forced Expiratory Volume in the first second (FEV1).

Results: Higher levels of participants' education were associated with lower exposures to PM and NO. Individuals with tertiary education had higher standardized FEV1 than individuals with primary education (88 % vs 95 %). Path analysis revealed a direct positive effect of education on FEV1, while about 12 % of the relationship between education and lung function was mediated by PM and NO CONCLUSIONS: Education (typically completed at young ages) appeared to have a protective effect on lung function later in life, and a small part of this effect was mediated by air pollution.