Sociodemographic and Geographic Risk Factors for All-Cause Mortality in Patients with COPD

Camille Robichaux; Jordan Aron; Chris H Wendt; Jesse D Berman; Austin Rau; Ann Bangerter; R Adams Dudley; Arianne K Baldomero

doi:10.2147/COPD.S406899

Sociodemographic and Geographic Risk Factors for All-Cause Mortality in Patients with COPD

Int J Chron Obstruct Pulmon Dis. 2023 Jul 25:18:1587-1593. doi: 10.2147/COPD.S406899. eCollection 2023.

Authors

Camille Robichaux¹, Jordan Aron², Chris H Wendt^{1

3}, Jesse D Berman⁴, Austin Rau⁴, Ann Bangerter⁵, R Adams Dudley^{1

3

5}, Arianne K Baldomero^{1

3

5}

Affiliations

¹ Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.
² Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA.
³ Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA.
⁴ Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA.
⁵ Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide. Identifying both individual and community risk factors associated with higher mortality is essential to improve outcomes. Few population-based studies of mortality in COPD include both individual characteristics and community risk factors.

Objective: We used geocoded, patient-level data to describe the associations between individual demographics, neighborhood socioeconomic status, and all-cause mortality.

Methods: We performed a nationally representative retrospective cohort analysis of all patients enrolled in the Veteran Health Administration with at least one ICD-9 or ICD-10 code for COPD in 2016-2019. We obtained demographic characteristics, comorbidities, and geocoded residential address. Area Deprivation Index and rurality were classified using individual geocoded residential addresses. We used logistic regression models to assess the association between these characteristics and age-adjusted all-cause mortality.

Results: Of 1,106,163 COPD patients, 33.4% were deceased as of January 2021. In age-adjusted models, having more comorbidities, Black/African American race (OR 1.09 [95% CI: 1.08-1.11]), and higher neighborhood disadvantage (OR 1.30 [95% CI: 1.28-1.32]) were associated with all-cause mortality. Female sex (OR 0.67 [95% CI: 0.65-0.69]), Asian race (OR 0.64, [95% CI: 0.59-0.70]), and living in a more rural area were associated with lower odds of all-cause mortality. After adjusting for age, comorbidities, neighborhood socioeconomic status, and rurality, the association with Black/African American race reversed.

Conclusion: All-cause mortality in COPD patients is disproportionately higher in patients living in poorer neighborhoods and urban areas, suggesting the impact of social determinants of health on COPD outcomes. Black race was associated with higher age-adjusted all-cause mortality, but this association was abrogated after adjusting for gender, socioeconomic status, comorbidities, and urbanicity. Future studies should focus on exploring mechanisms by which disparities arise and developing interventions to address these.

Keywords: chronic obstructive pulmonary disease; geography; race; social determinants; socioeconomic status.

Grants and funding

This research was supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute grant T32 HL007741-23 (CR) and National Center for Advancing Translational Sciences, grants KL2TR002492 and UL1TR002494 (AKB). This material is the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System. The views expressed in this article are those of the authors and do not reflect the views of the United States Government, the Department of Veterans Affairs, the National Institutes of Health, the National Institutes of Health’s National Center for Advancing Translational Sciences or any of the authors’ affiliated academic institutions.