<p>The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease</p>

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 (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. 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.

Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006–2017: Evidence from Spanish National Health Surveys

“…Previous studies have reported some factors that might be responsible for those changes in time in individuals with COPD. Thus, living in a disadvantaged neighborhood is associated with worse COPD-related outcomes, including functional limitations [ 80 ]. The available evidence has also shown that different personalities, resilience or coping styles, as well as paid work and a decline in economic conditions could help to explain the variation in the prevalence of functional limitation over the years [ 20 , 81 ].…”

Together In Care: An Enhanced Meals on Wheels Intervention Designed To Reduce Rehospitalizations Among Older Adults – Preliminary Findings

“…Socioeconomic status of a neighborhood has been shown to impact hospital admissions and readmissions. 11,24,25 With this insight, we now recognize more fully that some transition team impact, especially if only focused on medical management, may be signi cantly attenuated, if not entirely undone, by other factors patients face in a socioeconomically disadvantaged neighborhood (e.g., lack of access to nutritious food, social isolation, and unsafe homes). Addressing these "non-medical" variables, as demonstrated in our pilot, may certainly have contributed to the observed clinical and economic impact.…”

Disparities in access to food and chronic obstructive pulmonary disease (COPD)-related outcomes: a cross-sectional analysis

“…There is increasing recognition that the neighborhood environment can impact chronic disease risk and outcomes [ 37 – 39 ]. In fact, studies have shown that living in food deserts has been associated with adverse outcomes focusing on obesity, diabetes and heart diseases [ 19 – 22 , 40 , 41 ].…”

“…Food desert is a composite measure of low food access and neighborhood poverty [ 12 ]. Low individual SES has been a recognized risk factor for poor COPD outcomes [ 42 ] and additional evidence is suggesting that neighborhood SES is also associated with worse outcomes [ 37 – 39 ]. Other factors imbedded within the neighborhood SES, such as higher air pollutant exposures, may also have a variety of influences on respiratory morbidity that could further explain our findings [ 38 , 39 ].…”

“…Low individual SES has been a recognized risk factor for poor COPD outcomes [42] and additional evidence is suggesting that neighborhood SES is also associated with worse outcomes [37][38][39]. Other factors imbedded within the neighborhood SES, such as higher air pollutant exposures, may also have a variety of influences on respiratory morbidity that could further explain our findings [38,39]. When looking at food access alone, only a few studies have reported the association between availability of food stores and outcomes in chronic health conditions [20,21,37,38].…”