The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease

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

doi:10.2147/COPD.S238933

The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease

Int J Chron Obstruct Pulmon Dis. 2020 May 5:15:981-993. doi: 10.2147/COPD.S238933. eCollection 2020.

Authors

Panagis Galiatsatos¹, Han Woo¹, Laura M Paulin², Amy Kind^{3

4}, Nirupama Putcha¹, Amanda J Gassett⁵, Christopher B Cooper⁶, Mark T Dransfield⁷, Trisha M Parekh⁷, Gabriela R Oates⁸, R Graham Barr⁹, Alejandro P Comellas¹⁰, Meilan K Han¹¹, Stephen P Peters¹², Jerry A Krishnan¹³, Wassim W Labaki¹¹, Meredith C McCormack¹, Joel D Kaufman¹⁴, Nadia N Hansel¹

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Pulmonary and Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
³ University of Wisconsin School of Medicine and Public Health, Department of Medicine Health Services and Care Research Program and Division of Geriatrics, Madison, WI, USA.
⁴ Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA.
⁵ Internal Medicine, University of Washington, Seattle, WA, USA.
⁶ Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA, USA.
⁷ Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
⁸ Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA.
⁹ Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
¹⁰ Internal Medicine and Pulmonary, University of Iowa, Iowa City, IA, USA.
¹¹ Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
¹² Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
¹³ Department of Medicine, University of Illinois, Chicago, IL, USA.
¹⁴ Office of the Dean, University of Washington School of Public Health, Seattle, WA, USA.

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.

Keywords: COPD; area deprivation index; health disparities.

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

Abstract

MeSH terms

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