The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease

Panagis Galiatsatos,1 Han Woo,1 Laura M Paulin,2 Amy Kind,3,4 Nirupama Putcha,1 Amanda J Gassett,5 Christopher B Cooper,6 Mark T Dransfield,7 Trisha M Parekh,7 Gabriela R Oates,8 R Graham Barr,9 Alejandro P Comellas,10 Meilan K Han,11 Stephen P Peters,12 Jerry A Krishnan,13 Wassim W Labaki,11 Meredith C McCormack,1 Joel D Kaufman,14 Nadia N Hansel1 1Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Pulmonary and Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA; 3University of Wisconsin School of Medicine and Public Health, Department of Medicine Health Services and Care Research Program and Division of Geriatrics, Madison, WI, USA; 4Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA; 5Internal Medicine, University of Washington, Seattle, WA, USA; 6Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA, USA; 7Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA; 8Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA; 9Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA; 10Internal Medicine and Pulmonary, University of Iowa, Iowa City, IA, USA; 11Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA; 12Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA; 13Department of Medicine, University of Illinois, Chicago, IL, USA; 14Office of the Dean, University of Washington School of Public Health, Seattle, WA, USACorrespondence: Panagis GaliatsatosJohns Hopkins University School of Medicine, 4940 Eastern Avenue, Asthma and Allergy Building, 4th Floor, Baltimore, MD 21224, USATel +1410 550-0522Fax +1410 550-1094Email panagis@jhmi.eduRationale: 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: health disparities, COPD, area deprivation index