美国社区环境正义指数与哮喘和慢性阻塞性肺疾病患病率——一项基于人群的研究
Environmental justice index and prevalence of asthma and COPD in US neighborhoods- a population-based study.
作者信息
Khadke Sumanth, Khadke Vidhatri, Kumar Ashish, Makwana Bhargav, Dani Sourbha S, Al-Kindi Sadeer, Rajagopalan Sanjay, Kong Yixin, Nasir Khurram, Adamkiewicz Gary, Nohria Anju, Liesching Timothy N, Ganatra Sarju, Pinto-Plata Victor
机构信息
Division of Cardiovascular Medicine, Department of Internal Medicine, Lahey Hospital & Medical Center, 41 Mall Road, Burlington, MA, USA.
Center for Bioinformatics and Functional Genomics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
出版信息
Lancet Reg Health Am. 2025 Aug 5;49:101195. doi: 10.1016/j.lana.2025.101195. eCollection 2025 Sep.
BACKGROUND
The independent effects of social and environmental factors on asthma and chronic obstructive pulmonary disease (COPD) are well-documented, but less is known about their combined impact across US neighborhoods. This study aimed to determine the combined and individual associations of neighborhood-level social vulnerability and environmental burden with the prevalence of asthma and COPD.
METHODS
This cross-sectional study analyzed 71,677 US census tracts, linking the 2022 CDC Environmental Justice Index (EJI) rankings and its subcomponents (environmental burden module [EBM] and social vulnerability module [SVM]) to the 2023 CDC PLACES dataset. Multivariable quasi-Poisson regression with an offset function was used to compare covariate-adjusted risk ratios of health indicators across quartiles of neighborhood socio-environmental burden.
FINDINGS
Among the 71,677 neighborhoods studied, the median proportion of females was 50.90%. The median proportions of individuals aged 18 to 44, 45 to 64, and ≥65 were 30.6%, 26.7%, and 15.3%, respectively, with 22.6% of the Hispanic population. Asthma and COPD prevalence rates increased with increasing EJI and EBM quartiles. Neighborhoods with the highest socio-environmental burden (Q4 EJI) had significantly higher rates of asthma (RR:1.102, 95% CI: 1.087-1.117, p < 0.001) and COPD (RR:1.156, 95% CI:1.141-1.172, p < 0.001) compared to neighborhoods with the lowest burden (Q1 EJI), after adjusting for covariates. Similarly, neighborhoods with the highest environmental burden (Q4 EBM) had higher rates of asthma (RR: 1.091, 95% CI: 1.064-1.118, p < 0.001) and COPD (RR:1.099, 95% CI: 1.070-1.129, p < 0.001) compared with Q1 EBM, after adjusting for SVM and other covariates.
INTERPRETATION
A higher prevalence of obstructive lung disease is associated with neighborhoods experiencing high cumulative socio-environmental burden. Environmental burden showed an independent association with asthma and COPD prevalence, even after adjusting for social vulnerability and other factors.
FUNDING
None.
背景
社会和环境因素对哮喘和慢性阻塞性肺疾病（COPD）的独立影响已有充分记录，但对于它们在美国各社区的综合影响了解较少。本研究旨在确定社区层面的社会脆弱性和环境负担与哮喘和COPD患病率之间的综合及个体关联。
方法
这项横断面研究分析了71,677个美国人口普查区，将2022年美国疾病控制与预防中心环境正义指数（EJI）排名及其子成分（环境负担模块[EBM]和社会脆弱性模块[SVM]）与2023年美国疾病控制与预防中心PLACES数据集相关联。使用带有偏移函数的多变量准泊松回归来比较社区社会环境负担四分位数间健康指标的协变量调整风险比。
结果
在研究的71,677个社区中，女性的中位数比例为50.90%。年龄在18至44岁、45至64岁和≥65岁的个体中位数比例分别为30.6%、26.7%和15.3%，西班牙裔人口占22.6%。哮喘和COPD患病率随EJI和EBM四分位数的增加而上升。在调整协变量后，社会环境负担最高的社区（EJI Q4）的哮喘（RR：1.102，95% CI：1.087 - 1.117，p < 0.001）和COPD（RR：1.156，95% CI：1.141 - 1.172，p < 0.001）患病率显著高于负担最低的社区（EJI Q1）。同样，在调整SVM和其他协变量后，环境负担最高的社区（EBM Q4）的哮喘（RR：1.091，95% CI：1.064 - 1.118，p < 0.001）和COPD（RR：1.099，95% CI：1.070 - 1.129，p < 0.001）患病率高于EBM Q1。
解读
阻塞性肺病的较高患病率与经历高累积社会环境负担的社区相关。即使在调整社会脆弱性和其他因素后，环境负担与哮喘和COPD患病率仍显示出独立关联。
资金来源
无。
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