Title: The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease.

Authors: Galiatsatos, Panagis; Woo, Han; Paulin, Laura M; Kind, Amy; Putcha, Nirupama; Gassett, Amanda J; Cooper, Christopher B; Dransfield, Mark T; Parekh, Trisha M; Oates, Gabriela R; Barr, R Graham; Comellas, Alejandro P; Han, Meilan K; Peters, Stephen P; Krishnan, Jerry A; Labaki, Wassim W; McCormack, Meredith C; Kaufman, Joel D; Hansel, Nadia N

Published In Int J Chron Obstruct Pulmon Dis, (2020)

Abstract: Rationale: Individual socioeconomic status has been shown to influence the outcomes of patients with chronic obstructive pulmonary disease (COPD). However, contextual factors may also play a role. The objective of this study is to evaluate the association between neighborhood socioeconomic disadvantage measured by the area deprivation index (ADI) and COPD-related outcomes. Methods: Residential addresses of SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) subjects with COPD (FEV1/FVC <0.70) at baseline were geocoded and linked to their respective ADI national ranking score at the census block group level. The associations between the ADI and COPD-related outcomes were evaluated by examining the contrast between participants living in the most-disadvantaged (top quintile) to the least-disadvantaged (bottom quintile) neighborhood. Regression models included adjustment for individual-level demographics, socioeconomic variables (personal income, education), exposures (smoking status, packs per year, occupational exposures), clinical characteristics (FEV1% predicted, body mass index) and neighborhood rural status. Results: A total of 1800 participants were included in the analysis. Participants residing in the most-disadvantaged neighborhoods had 56% higher rate of COPD exacerbation (P<0.001), 98% higher rate of severe COPD exacerbation (P=0.001), a 1.6 point higher CAT score (P<0.001), 3.1 points higher SGRQ (P<0.001), and 24.6 meters less six-minute walk distance (P=0.008) compared with participants who resided in the least disadvantaged neighborhoods. Conclusion: Participants with COPD who reside in more-disadvantaged neighborhoods had worse COPD outcomes compared to those residing in less-disadvantaged neighborhoods. Neighborhood effects were independent of individual-level socioeconomic factors, suggesting that contextual factors could be used to inform intervention strategies targeting high-risk persons with COPD.

PubMed ID: 32440110

MeSH Terms: Body Mass Index; Humans; Pulmonary Disease, Chronic Obstructive*/diagnosis; Pulmonary Disease, Chronic Obstructive*/epidemiology; Pulmonary Disease, Chronic Obstructive*/therapy; Residence Characteristics; Social Class; Socioeconomic Factors