Patients with COPD living in socially vulnerable areas have decreased lung function
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Key takeaways:
- Residing in a socially vulnerable area contributed to reduced lung function in those with COPD.
- Socioeconomic status, along with household composition and disability, negatively impacted lung function.
WASHINGTON — Initial measures of lung function were reduced in patients with COPD who lived in socially vulnerable communities, according to an abstract presented at the American Thoracic Society International Conference.
“The largest contributors to lung function deficits are socioeconomic status and household composition and disability and, with additional negative consequence of housing and transportation and minority status and [language],” Gabriela R. Oates, PhD, associate professor of pediatric pulmonary medicine at The University of Alabama at Birmingham, and colleagues wrote.
In a longitudinal analysis of The University of Alabama at Birmingham Health System between 2010 and 2020, Oates and colleagues evaluated 11,767 patients with COPD to see how baseline pre-bronchodilator lung function and annual changes in lung function are impacted by neighborhood vulnerability.
Researchers evaluated the social vulnerability of a patients’ residence through the CDC Social Vulnerability Index (SVI), which includes 15 variables from the U.S. census to determine if an area is “socially vulnerable to disaster,” according to the CDC website.
Researchers then used multivariable linear mixed models that accounted for age, sex, race, ethnicity, martial status, smoking status, obesity and comorbidities to assess how SVI impacted FEV1 at baseline and over 1 year.
In addition to overall SVI scores, Oates and colleagues evaluated four sub scores from the index to see which was estimated to have the greatest negative effect on lung function. These sub scores specifically captured socioeconomic status; household composition and disability; minority status and language; and housing and transportation.
At least two FEV1 datapoints were found for 6,359 patients (54%), and the mean percent predicted FEV1 at baseline was 69.5% (standard deviation, 23.38), with a mean FEV1 decline of 1.3% over a year, according to the abstract.
Researchers found that overall SVI was linked to a decrease of 6.9% of percent predicted FEV1 at baseline (P < .0001). Further, all the evaluated individual SVI sub scores showed reduced lung function at baseline, with socioeconomic status showing the largest decline of –7.5% (P < .0001), followed by household composition and disability with –5.3% (P < .0001), housing and transportation with –3.9% (P < .0001) and minority status and language with –2.4% (P = .0047).
Overall SVI scores were also related to an annual 0.9% decrease in percent predicted FEV1 (P < .01). In terms of sub scores of neighborhood vulnerability, researchers observed an annual percent predicted FEV1 change of –0.8% linked to socioeconomic status, as well as housing and transportation (P < .01). Minority status and language was also linked to a decrease in lung function over a year (–0.5%; P < .05).
“These risk factors can be used as intervention targets in future research seeking to ameliorate the adverse effects of the social environment on lung health,” Oates and colleagues wrote.
References:
- CD/ATSDR Social vulnerability index. https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. Published Nov. 16, 2022. Accessed May 18, 2023.
- Social Vulnerability Index. https://data.cdc.gov/Vaccinations/Social-Vulnerability-Index/ypqf-r5qs. Published June 17, 2021. Accessed May 18, 2023.
Perspective
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Although the results of this study are not surprising, the findings are very significant and generalizable to a broader population. The study highlights a group that needs aggressive diagnosis and treatment of COPD, and these individuals are likely at greater risk for exacerbations and health care utilization. We see similar results working in an urban northeastern U.S. setting, highlighting that this is a nationwide issue. It is vitally important that health care workers take into account social vulnerability when treating patients with COPD. We need to place more emphasis on early diagnosis of COPD as well as risk factor modification such as smoking cessation, but also education on protecting themselves from occupational exposures. Many in this group are far more likely to be working in environments where they are exposed to dust, fumes, vapors and gas which are associated with more severe COPD. This research report is preliminary and will need to be submitted for publication to undergo peer review. The next step will be to determine how social vulnerability leads to worse COPD outcomes and how to counteract these findings by ensuring a timely diagnosis, improving access to appropriate medical therapy and most importantly have risk factor modifications to reduce likelihood of progression (ie, smoking cessation).
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