Poor Neighborhoods Affect Individual Health Outcomes in Those With COPD, Study Says

It is already known that individual socioeconomic status is linked with worse outcomes in chronic obstructive pulmonary disease (COPD), but what isn’t known is the extent to which the poverty of a neighborhood may influence individual outcomes as well. A recent study examined this association by looking at the area deprivation index (ADI) and COPD-related outcomes, using the hypothesis that patients from neighborhoods that had low ADI scores would have worse outcomes than those from wealthier areas, even after controlling for individual variables.

COPD affects nearly 27 million people in the United States and causes nearly 3 million deaths per year; in addition, it is a chronic disease known to have significant racial, ethnic and gender disparities.

The findings indicated that living in a disadvantaged neighborhood is associated with worse COPD-related individual-level outcomes, including exacerbation risk, respiratory symptoms, functional capacity, and quality of life, even after accounting for measured individual socioeconomic variables, tobacco use, and occupational exposure to vapor, dust, gas or fumes.

Researchers used the Area Deprivation Index (ADI), a geospatial index of socioeconomic disadvantage that drills down to block-level information; it is drawn from US Census data and updated to incorporate 2013 American Community Survey data. The ADI reports a value from 1 (least disadvantaged) to 100 (most disadvantaged) and is a composite score constructed from 17 indicators in the area of income, education, housing, employment, home and vehicle ownership, and family structure. Each indicator is weighted by factor score coefficients.

Researchers looked at the contrast between patients living in the most-disadvantaged (top quintile) to the least-disadvantaged (bottom quintile) neighborhood and the associations with COPD-related outcomes.

Patient information was taken from the SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) and the SPIROMICS AIR study. SPIROMICS is a prospective cohort study that has enrolled geographically diverse patients aged 40 to 80 years old with COPD, along with smokers without COPD and non-smokers, across 12 US sites.

Participants had post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV₁:FVC) of less than 0.70. Their baseline data were geocoded and linked to their respective ADI national ranking score for their address.

Variables included in the regression model were:

• Individual-level demographics
• Individual socioeconomic status, as measured by education (more than high school vs. high school or less); income (≤$49,000, ≥$50,000, or no answer); and marital status (married vs. not married)
• Exposures (smoking status, packs per year, occupational exposures)
• Clinical characteristics (FEV₁% predicted, body mass index (BMI), performance on the 6-minute walk test, number of exacerbations)
• Neighborhood rural status

A total of 1799 participants were included for analysis. The mean (SD) ADI national ranking was 41.0(29.4) (range, 1 to 100), and the median was 37 (interquartile range, 47).

Participants residing in more disadvantaged neighborhoods had lower education, less income, and were less likely to be married compared to those residing in less disadvantaged neighborhood; they were also younger, and more likely to be females, non-white, current smokers, and live in urban areas. There was no ADI difference for BMI or pack years.

Those residing in the most-disadvantaged neighborhoods had 56% higher rate of COPD exacerbation (P < .001); 98% higher rate of severe COPD exacerbation (P = .001); worse respiratory symptoms (P < .001); and worse respiratory quality of life (P < .001). They also had less functional capacity, walking 24.6 meters less on the 6-minute walk distance test (P = .008).

The results indicate that interventions are needed that target neighborhood-level socioeconomic factors for improvement, in addition to efforts aimed at individual health, the authors concluded.

Reference

Galiatsatos P, Woo H, Paulin LM, et al.The association between neighborhood socioeconomic disadvantage and chronic obstructive pulmonary disease.

Int J Chron Obstruct Pulmon Dis. Published May 5, 2020. doi.org/10.2147/COPD.S238933