Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Pulmonary and Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Int J Chron Obstruct Pulmon Dis. 2020 May 5;15:981-993. doi: 10.2147/COPD.S238933. eCollection 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/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% 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.
个体社会经济地位已被证明会影响慢性阻塞性肺疾病（COPD）患者的结局。然而，环境因素也可能起作用。本研究旨在评估用地区剥夺指数（ADI）衡量的邻里社会经济劣势与 COPD 相关结局之间的关系。
在基线时患有 COPD（FEV/FVC＜0.70）的 SubPopulations and InteRmediate Outcome Measures in COPD Study（SPIROMICS）受试者的居住地址被地理编码，并与各自的按普查区组水平排列的 ADI 全国排名得分相联系。通过比较居住在最不利（前 quintile）和最有利（后 quintile）邻里的参与者，评估 ADI 与 COPD 相关结局之间的关系。回归模型包括对个体水平人口统计学、社会经济变量（个人收入、教育）、暴露（吸烟状况、每年吸烟量、职业暴露）、临床特征（FEV%预测值、体重指数）和邻里农村状况进行调整。
共纳入 1800 名参与者进行分析。与居住在最不利邻里的参与者相比，居住在最有利邻里的参与者 COPD 加重率高 56%（P＜0.001），重度 COPD 加重率高 98%（P=0.001），CAT 评分高 1.6 分（P＜0.001），SGRQ 评分高 3.1 分（P＜0.001），6 分钟步行距离少 24.6 米（P=0.008）。
与居住在较不利邻里的参与者相比，居住在较不利邻里的 COPD 患者的 COPD 结局更差。邻里效应独立于个体社会经济因素，这表明环境因素可用于为 COPD 高危人群提供干预策略。
