Telomere Length and Prevalent Chronic Lung Disease in Middle-Aged and Older Adults: Socioeconomic Heterogeneity and Early-Life Tobacco Exposure in the Health and Retirement Study

Introduction: Telomere shortening is a hallmark of aging and age-related diseases, yet evidence linking it to pulmonary diseases remains limited. Methods: We included 4,994 participants aged ≥50 years from the 2008 HRS wave with available telomere measurement data. Pulmonary disease status was defined using the 2008 HRS self-reported physician-diagnosed chronic lung disease item, which includes conditions such as chronic bronchitis or emphysema and excludes asthma. Multivariable logistic regression models were used to examine the association between telomere length and the odds of prevalent chronic lung disease. Stratified analyses, restricted cubic spline (RCS) regression, and sensitivity analyses were conducted. Results: Each interquartile range (IQR) increase in telomere length was associated with a 14.3% lower odds of prevalent pulmonary disease (adjusted OR = 0.857, 95% CI: 0.774–0.945, P=0.002). Participants in the longest telomere quartile (Q4) exhibited 38.0% lower odds compared to those in the shortest quartile (Q1). However, after excluding participants exposed to parental smoking during childhood, the association was attenuated and was no longer statistically significant (OR = 0.901, 95% CI: 0.736–1.091, P = 0.297). Discussion: Telomere shortening may be biologically related to pulmonary disease-related processes via cellular senescence and chronic inflammation. Shorter telomere length was associated with higher odds of prevalent self-reported chronic lung disease in the full sample; however, this association became non-significant after excluding participants exposed to parental smoking during childhood, indicating that the full-sample association should not be interpreted as independent of early-life tobacco exposure. Longitudinal studies are needed to clarify temporality.