Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease.

TitleRacial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease.
Publication TypePublication
Year2021
AuthorsWoo H, Brigham EP, Allbright K, Ejike C, Galiatsatos P, Jones MR, Oates GR, Krishnan JA, Cooper CB, Kanner RE, Bowler RP, Hoffman EA, Comellas AP, Criner G, R Barr G, Martinez FJ, Han ML, Ortega VE, Parekh TM, Christenson S, Belz D, Raju S, Gassett A, Paulin LM, Putcha N, Kaufman JD, Hansel NN
JournalAm J Respir Crit Care Med
Volume204
Issue5
Pagination536-545
Date Published2021 Sep 01
ISSN1535-4970
KeywordsAdult, African Americans, Aged, Aged, 80 and over, Female, Health Status Disparities, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Residence Characteristics, Social Class, Social Segregation, Surveys and Questionnaires, United States, Urban Population
Abstract

Racial residential segregation has been associated with worse health outcomes, but the link with chronic obstructive pulmonary disease (COPD) morbidity has not been established. To investigate whether racial residential segregation is associated with COPD morbidity among urban Black adults with or at risk of COPD. Racial residential segregation was assessed using isolation index, based on 2010 decennial census and baseline address, for Black former and current smokers in the multicenter SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), a study of adults with or at risk for COPD. We tested the association between isolation index and respiratory symptoms, physiologic outcomes, imaging parameters, and exacerbation risk among urban Black residents, adjusting for established COPD risk factors, including smoking. Additional mediation analyses were conducted for factors that could lie on the pathway between segregation and COPD outcomes, including individual and neighborhood socioeconomic status, comorbidity burden, depression/anxiety, and ambient pollution. Among 515 Black participants, those residing in segregated neighborhoods (i.e., isolation index ⩾0.6) had worse COPD Assessment Test score (β = 2.4; 95% confidence interval [CI], 0.7 to 4.0), dyspnea (modified Medical Research Council scale; β = 0.29; 95% CI, 0.10 to 0.47), quality of life (St. George's Respiratory Questionnaire; β = 6.1; 95% CI, 2.3 to 9.9), and cough and sputum (β = 0.8; 95% CI, 0.1 to 1.5); lower FEV% predicted (β = -7.3; 95% CI, -10.9 to -3.6); higher rate of any and severe exacerbations; and higher percentage emphysema (β = 2.3; 95% CI, 0.7 to 3.9) and air trapping (β = 3.8; 95% CI, 0.6 to 7.1). Adverse associations attenuated with adjustment for potential mediators but remained robust for several outcomes, including dyspnea, FEV% predicted, percentage emphysema, and air trapping. Racial residential segregation was adversely associated with COPD morbidity among urban Black participants and supports the hypothesis that racial segregation plays a role in explaining health inequities affecting Black communities.

DOI10.1164/rccm.202009-3721OC
Alternate JournalAm J Respir Crit Care Med
PubMed ID33971109
PubMed Central IDPMC8491265
Grant ListP50 MD010431 / MD / NIMHD NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
P30 ES005605 / 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
K23 HL153672 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
T32 HL007534 / HL / NHLBI NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
K23 ES029105 / ES / NIEHS NIH HHS / United States
MS#: 
MS178
Manuscript Full Title: 
Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Baltimore (Johns Hopkins University)
ECI: 
Manuscript Status: 
Published and Public