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      The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease

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          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.


          Residential addresses of SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) subjects with COPD (FEV 1/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 (FEV 1% predicted, body mass index) and neighborhood rural status.


          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.


          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.

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          Most cited references 37

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          Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.

          Measures of socioeconomic disadvantage may enable improved targeting of programs to prevent rehospitalizations, but obtaining such information directly from patients can be difficult. Measures of U.S. neighborhood socioeconomic disadvantage are more readily available but are rarely used clinically.
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            The economic impact of exacerbations of chronic obstructive pulmonary disease and exacerbation definition: a review.

            Chronic obstructive pulmonary disease (COPD) poses a significant economic burden on society, and a substantial portion is related to exacerbations of COPD. A literature review of the direct and indirect costs of COPD exacerbations was performed. A systematic search of the MEDLINE database from 1998-2008 was conducted and supplemented with searches of conference abstracts and article bibliographies. Articles that contained cost data related to COPD exacerbations were selected for in-depth review. Eleven studies examining healthcare costs associated with COPD exacerbations were identified. The estimated costs of exacerbations vary widely across studies: $88 to $7,757 per exacerbation (2007 US dollars). The largest component of the total costs of COPD exacerbations was typically hospitalization. Costs were highly correlated with exacerbation severity. Indirect costs have rarely been measured. The wide variability in the cost estimates reflected cross-study differences in geographic locations, treatment patterns, and patient populations. Important methodological differences also existed across studies. Researchers have used different definitions of exacerbation (e.g., symptom- versus event-based definitions), different tools to identify and measure exacerbations, and different classification systems to define exacerbation severity. Unreported exacerbations are common and may influence the long-term costs of exacerbations. Measurement of indirect costs will provide a more comprehensive picture of the burden of exacerbations. Evaluation of pharmacoeconomic analyses would be aided by the use of more consistent and comprehensive approaches to defining and measuring COPD exacerbations.
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              Design of the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS).

              Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS) is a multicentre observational study of chronic obstructive pulmonary disease (COPD) designed to guide future development of therapies for COPD by providing robust criteria for subclassifying COPD participants into groups most likely to benefit from a given therapy during a clinical trial, and identifying biomarkers/phenotypes that can be used as intermediate outcomes to reliably predict clinical benefit during therapeutic trials. The goal is to enrol 3200 participants in four strata. Participants undergo a baseline visit and three annual follow-up examinations, with quarterly telephone calls. Adjudication of exacerbations and mortality will be undertaken.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                05 May 2020
                : 15
                : 981-993
                [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
                Author notes
                Correspondence: Panagis Galiatsatos Johns Hopkins University School of Medicine , 4940 Eastern Avenue, Asthma and Allergy Building, 4th Floor, Baltimore, MD21224, USATel +1410 550-0522Fax +1410 550-1094 Email
                © 2020 Galiatsatos et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (

                Page count
                Figures: 3, Tables: 3, References: 52, Pages: 13
                The Area Deprivation Index variable was supported by National Institutes of Health-National Institute on Minority Health and Health Disparities Award (R01MD010243 [PI Kind]). This material is the result of work also supported with the resources and the use of facilities at the William S Middleton Memorial Veterans Hospital Geriatric Research, Education and Clinical Center in Madison, WI and the University of Wisconsin Department of Medicine Health Services and Care Research Program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US Department of Veterans Affairs.
                Original Research

                Respiratory medicine

                health disparities, copd, area deprivation index


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