Disadvantaged Neighborhoods Suffer More Asthma, COPD

BOSTON — In a first-of-its-kind analysis, researchers linked a heightened incidence of asthma and chronic obstructive pulmonary disease (COPD) to more socially and environmentally disadvantaged neighborhoods. Similar associations have been found in the past, but they generally looked at single variables. The new work used a national neighborhood database and took into account neighborhood-level environmental and 14 social factors like poverty, unemployment, and poor housing conditions and 17 environmental factors such as air pollution and proximity to toxic sites.

“We found that in the most disadvantaged neighborhoods had a about a one and a half percent higher prevalence of asthma and a three percent higher prevalence of COPD compared to the most advantaged neighborhoods. We broke it down into four categories of neighborhoods, and everything outside of the top-most advantaged neighborhoods had increased asthma and COPD and went in a stepwise fashion where as you went to more disadvantaged neighborhoods, the prevalence went higher and higher,” said Stephen Mein, MD, a pulmonary fellow at Harvard Medical School, Boston, who presented the study at the American College of Chest Physicians (CHEST) 2024 Annual Meeting.

He pointed out that there is increasing evidence of complex interactions between exposures. “We know that [for example] air pollution potentially affects low-income vs high-income neighborhoods differently, and so being able to combine both the socioeconomic and the environmental [exposures gives] a complete picture of the neighborhood analysis,” said Mein.

Mein cited an example from another study by his group, which looked at cardiovascular disease. It showed that exposure to air and water pollution and toxic sites is associated with a higher prevalence of cardiovascular disease and associated risk factors. “But then when we broke it down by social vulnerability, the association was even stronger. So there are probably interactions that we’re not fully understanding or that we haven’t fully captured,” said Mein. The group next plans to look at clinical outcomes like hospitalization and emergency department visits by neighborhood with respect to environmental and social exposures.

In the new study, the researchers used data from the Centers for Disease Control PLACES dataset and the US Census Bureau’s American Community Survey to determine neighborhood-level sociodemographic characteristics and asthma and COPD prevalence among US adults. They divided 71,659 neighborhoods of 306,156,446 individuals into quartiles based on the 2022 Environmental Justice Index (EJI).

The neighborhoods with the highest EJI, representing the most environmentally burdened and socially vulnerable neighborhoods, had higher rates of asthma (11.0% vs 9.0%; adjusted difference, 1.56%; 95% CI, 1.48-1.64) and COPD (8.7% vs 5.9%; adjusted difference, 2.92%; 95% CI, 2.77-3.07).

The work should help inform efforts to improve social equity, according to Mein. “I think a lot of people here at CHEST do a really good job of thinking about it from a neighborhood perspective and how do we [improve equity] either through our health systems or through neighborhood interventions, community centers, and things like that. But then I think also some of it is going to be from a national policy perspective,” said Mein. He pointed to the Justice40 Initiative that aims to funnel 40% of benefits from Federal climate, clean energy, affordable and sustainable housing, and other investments to disadvantaged communities with a high pollution burden.

“I think both from like a sort of a grassroots on the ground system, and then also from a policy perspective, will be helpful,” said Mein.

The study drew praise from Wilson Quezada, MD, associate professor of medicine in the Department of Pulmonary Care at Columbia University in the city of New York, who moderated the session. “I think it’s very interesting. First of all, [their] use of EJI is an amazing use of that tool. Together with the other databases that they used, I think it provided a very comprehensive picture of the patient’s environment and the incidence of obstructive lung diseases,” said Quezada.

He lauded EJI more generally, emphasizing its ease of use and comprehensive nature. “It’s the one of the best ways that we have of looking at the patient as a whole, instead of looking at the disease in the context of the patient. I think that’s unique, and best of all, it’s available and free for everybody to use. You can log in and just plug in your zip code, and you can see what the burden is in your area,” said Quezada.

Mein and Quezada reported no relevant financial relationships.

Jim Kling is a writer in Bellingham, Washington.