Contribution of Individual and Neighborhood Factors to Racial Disparities in Respiratory Outcomes.

TitleContribution of Individual and Neighborhood Factors to Racial Disparities in Respiratory Outcomes.
Publication TypePublication
Year2021
AuthorsEjike CO, Woo H, Galiatsatos P, Paulin LM, Krishnan JA, Cooper CB, Couper DJ, Kanner RE, Bowler RP, Hoffman EA, Comellas AP, Criner GJ, R Barr G, Martinez FJ, Han MK, Martinez CH, Ortega VE, Parekh TM, Christenson SA, Thakur N, Baugh A, Belz DC, Raju S, Gassett AJ, Kaufman JD, Putcha N, Hansel NN
JournalAm J Respir Crit Care Med
Volume203
Issue8
Pagination987-997
Date Published2021 04 15
ISSN1535-4970
KeywordsAdult, African Americans, Aged, Aged, 80 and over, Female, Health Status Disparities, Healthcare Disparities, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Pulmonary Disease, Chronic Obstructive, Race Factors, smoking, Social Class, Socioeconomic Factors, Surveys and Questionnaires, Whites
Abstract

Black adults have worse health outcomes compared with white adults in certain chronic diseases, including chronic obstructive pulmonary disease (COPD). To determine to what degree disadvantage by individual and neighborhood socioeconomic status (SES) may contribute to racial disparities in COPD outcomes. Individual and neighborhood-scale sociodemographic characteristics were determined in 2,649 current or former adult smokers with and without COPD at recruitment into SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). We assessed whether racial differences in symptom, functional, and imaging outcomes (St. George's Respiratory Questionnaire, COPD Assessment Test score, modified Medical Research Council dyspnea scale, 6-minute-walk test distance, and computed tomography [CT] scan metrics) and severe exacerbation risk were explained by individual or neighborhood SES. Using generalized linear mixed model regression, we compared respiratory outcomes by race, adjusting for confounders and individual-level and neighborhood-level descriptors of SES both separately and sequentially. After adjusting for COPD risk factors, Black participants had significantly worse respiratory symptoms and quality of life (modified Medical Research Council scale, COPD Assessment Test, and St. George's Respiratory Questionnaire), higher risk of severe exacerbations and higher percentage of emphysema, thicker airways (internal perimeter of 10 mm), and more air trapping on CT metrics compared with white participants. In addition, the association between Black race and respiratory outcomes was attenuated but remained statistically significant after adjusting for individual-level SES, which explained up to 12-35% of racial disparities. Further adjustment showed that neighborhood-level SES explained another 26-54% of the racial disparities in respiratory outcomes. Even after accounting for both individual and neighborhood SES factors, Black individuals continued to have increased severe exacerbation risk and persistently worse CT outcomes (emphysema, air trapping, and airway wall thickness). Disadvantages by individual- and neighborhood-level SES each partly explain disparities in respiratory outcomes between Black individuals and white individuals. Strategies to narrow the gap in SES disadvantages may help to reduce race-related health disparities in COPD; however, further work is needed to identify additional risk factors contributing to persistent disparities.

DOI10.1164/rccm.202002-0253OC
Alternate JournalAm J Respir Crit Care Med
PubMed ID33007162
PubMed Central IDPMC8048743
Grant ListP50 MD010431 / MD / NIMHD NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
K23 ES025781 / ES / NIEHS NIH HHS / United States
R01 ES023500 / ES / NIEHS NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
K23 HL153672 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
K24 HL138188 / HL / NHLBI NIH HHS / United States
T32 HL007534 / HL / NHLBI NIH HHS / United States
P30 AI094189 / AI / NIAID NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
K23 HL123778 / HL / NHLBI NIH HHS / United States
K24 HL137013 / HL / NHLBI NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
MS#: 
MS178
Manuscript Full Title: 
Contribution of Individual and Neighborhood Factors to Racial Disparities in Respiratory Outcomes.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Baltimore (Johns Hopkins University)
ECI: 
Manuscript Status: 
Published and Public