Respiratory disease mortality variations linked to county-level sociodemographics

Variations in chronic respiratory disease mortality appeared to be associated with U.S. county-level sociodemographic vulnerabilities, researchers reported in Annals of the American Thoracic Society.

“[T]here are significant variations in respiratory disease mortality among U.S. counties,” Yu-Che Lee, MD, MPH, resident physician in the department of medicine at the University of Buffalo-Catholic Health System, New York, and colleagues wrote. “County-level sociodemographic vulnerabilities as assessed by Social Vulnerability Index, subindices and county characteristics were significantly associated with chronic respiratory diseases mortality.”

The cross-sectional study evaluated data on chronic respiratory diseases among U.S. counties for 2014 to 2018 from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Using the Social Vulnerability Index (SVI), researchers evaluated county-level sociodemographic vulnerabilities to disasters, including subindices of socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Researchers classified county-level sociodemographic characteristics from the SVI percentile rank into quartiles, with higher quartiles indicating greater vulnerability.

From 2014 to 2018, the age-adjusted mortality per 1,000,000 population was 406.4 for chronic lower respiratory disease, 393.7 for COPD, 10 for asthma, 50.5 for interstitial lung disease, 37 for idiopathic pulmonary fibrosis and 5.3 for sarcoidosis, according to the results.

The researchers reported significant associations among counties in the higher SVI quartile for mortality from chronic lower respiratory disease (incidence rate ratio [IRR] = 1.43; 95% CI, 1.39-1.48), COPD (IRR = 1.44; 95% CI, 1.39-1.49), asthma (IRR = 2.06; 95% CI, 1.71-2.48), ILD (IRR = 1.07; 95% CI, 1.02-1.13), IPF (IRR = 1.14; 95% CI, 1.06-1.22) and sarcoidosis (IRR = 2.01; 95% CI, 1.44-2.81).

In addition, researchers also found higher mortality among counties in the higher SVI quartile of each of the subindices and most sociodemographic characteristics.

“These findings suggested that social determinants of health are considered a large driven force and may add a considerable barrier to establishing health equity in respiratory diseases,” the researchers wrote. “Multilevel public health strategies and clinical interventions addressing inequitable outcomes of chronic respiratory diseases should be developed and targeted on areas with great social disadvantage.”