BACKGROUND Pulmonary decline in CF is heterogeneous, with socio-environmental factors contributing to this variability. Few studies have attempted to disentangle the effects of tobacco smoke exposure and socioeconomic factors on lung function deterioration in pediatric CF. The current study evaluates their contributions longitudinally across the entire U.S. CF care network population. METHODS Data from the CF Foundation Patient Registry were obtained on all individuals who at the end of 2016 were 6-18 years old. Lung function measures (ppFEV1) for each person were calculated at each attained age. Multivariable analyses used mixed modeling to assess the impact of smoke exposure and socioeconomic factors on initial lung function and change over time. RESULTS The sample included 10,895 individuals contributing 65,581 person years. At age 6, ppFEV1 of smoke-exposed children was 4.7% lower than among unexposed. The deficit persisted through age 18. In adjusted mixed models, smoke exposure and socioeconomic factors had independent, additive associations with lung function. Median ppFEV1 declined 2.4% with smoke exposure, 4.9% with lower paternal education, 0.3% with public insurance, and increased 0.2% with each $10,000 annual household income. The effect of smoke exposure on ppFEV1 was larger in disadvantaged children compared to privileged counterparts (3.2% vs 1.2%). CONCLUSIONS Smoke exposure and socioeconomic factors are independent risk factors for decreased ppFEV1 in pediatric CF. Smoking cessation strategies should be emphasized at the time of CF diagnosis and reiterated during infancy and early childhood. Interventions may be prioritized in disadvantaged families, where the exposure has a disproportionately large effect.

中文翻译：

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烟草烟雾暴露和社会经济因素是儿童囊性纤维化肺功能衰退的独立预测因素

背景 CF 的肺功能下降是异质的，社会环境因素导致了这种变异性。很少有研究试图解开烟草烟雾暴露和社会经济因素对儿科 CF 肺功能恶化的影响。当前的研究纵向评估了他们在整个美国 CF 护理网络人群中的贡献。方法 从 CF 基金会患者登记处获得了 2016 年底所有 6-18 岁个体的数据。在每个达到的年龄计算每个人的肺功能测量值 (ppFEV1)。多变量分析使用混合模型来评估烟雾暴露和社会经济因素对初始肺功能和随时间变化的影响。结果 样本包括 10,895 个人，贡献了 65,581 人年。6岁时，吸烟儿童的 ppFEV1 比未吸烟儿童低 4.7%。这种缺陷持续到 18 岁。在调整后的混合模型中，烟雾暴露和社会经济因素与肺功能具有独立的、相加的关联。中位数 ppFEV1 因吸烟而下降 2.4%，因父亲教育程度较低而下降 4.9%，因公共保险下降 0.3%，家庭年收入每 10,000 美元则上升 0.2%。与特权儿童相比，吸烟对弱势儿童 ppFEV1 的影响更大（3.2% 对 1.2%）。结论 烟雾暴露和社会经济因素是儿童 CF 中 ppFEV1 降低的独立危险因素。应在 CF 诊断时强调戒烟策略，并在婴儿期和幼儿期重申。可能优先考虑弱势家庭的干预措施，