Living in neighborhoods with a high environmental burden linked with asthma, COPD
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Key takeaways:
- Neighborhoods with the highest EJI scores saw higher rates of both asthma and COPD.
- Smoking worsened the association between EJI and asthma/COPD.
BOSTON — People living in disadvantaged neighborhoods that see a high environmental burden or social vulnerability score experienced increased rates of asthma and COPD, according to an abstract presented at the CHEST Annual Meeting.
“From prior studies, we know that both environmental exposures (eg, air pollution) and socioeconomic disadvantage (eg, poor housing conditions or low income) are associated with higher prevalence of asthma and COPD and/or more severe disease,” Stephen Mein, MD, fellow in pulmonary and critical care medicine at Massachusetts General Hospital and Beth Israel Deaconess Medical Center, told Healio.
“However, the majority of these studies only assessed a limited number of factors despite a growing understanding that these neighborhood characteristics often occur simultaneously, which may compound their individual effects,” he continued. “We used a novel, neighborhood-level socioenvironmental assessment tool developed by the CDC to evaluate associations between a comprehensive measurement of socioeconomic disadvantage and environmental burden and asthma and COPD prevalence.”
This cross-sectional study used data from the 2020 CDC PLACES and 2018 American Community Survey to gather neighborhood level information on the sociodemographic characteristics and asthma/COPD prevalence among adults within the United States.
Based on the 2022 Environmental Justice Index (EJI), neighborhoods were divided into quartiles. The EJI is the first national, granular and comprehensive measure of a neighborhood’s exposome, which is made up from 17 environmental indicators such as air pollution and proximity to toxic sites as well as 14 social indicators such as poverty, unemployment and poor housing conditions.
An estimated 306 million individuals resided within the 71,659 neighborhoods included in the study. Neighborhoods that were the most environmentally burdened and socially vulnerable, with the highest EJI, were more likely to be younger compared with neighborhoods with the lowest EJI, with a median age of 35 (interquartile range [IQR], 31-39) vs. 42 (IQR, 38-47). They were almost mostly located in the South (37% vs. 32.1%) and Northeast (20% vs. 17.4%).
Neighborhoods with the highest EJI had significantly higher rates of asthma compared with neighborhoods with the lowest EJI with a mean of 11% (standard deviation [SD], 1.8%) vs. 9% (SD, 1.1%) with an adjusted difference of 1.56% (95% CI, 1.48-1.64)
Similarly, COPD rates included 8.7% (SD, 2.7%) for neighborhoods with the highest EJI and 5.9% (SD, 2%) for the neighborhoods with the lowest EJI, with an adjusted difference of 2.92% (95% CI, 2.77-3.07).
The researchers noted a dose-dependent relationship as well, as neighborhoods with increasing levels of EJI also had incrementally higher rates of asthma and COPD. Differences in smoking rates completely drove the association between asthma prevalence and EJI, the researchers said, and attenuated the association between COPD prevalence and EJI.
“We were surprised by the stepwise increase in asthma and COPD prevalence with worsening neighborhood social and environmental disadvantage, and the magnitude of the difference in disease prevalence between the most disadvantaged and least disadvantaged neighborhoods,” Mein said. “We found almost a 50% higher prevalence of COPD in the most disadvantaged neighborhoods, suggesting that socioeconomic and environmental factors may play a key role in the prevalence of obstructive lung disease.”
Mein further emphasized that the results of his research should add further evidence to the importance of screening patients for social determinants of health that may place them at higher risk for developing disease.
“Our research is meant to generate discussion around the cumulative impact of social and environmental factors and lay the foundation for future studies evaluating the effects of one’s neighborhood on disease outcomes,” he said. “It also provides further evidence of the need for policy and public health interventions to improve the neighborhood exposome to reduce longstanding inequities in respiratory health.”
For more information:
Stephen Mein, MD, can be reached at smein@bidmc.harvard.edu