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 Hansel 1
05 May 2020
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.