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

Chinedu O Ejike; Han Woo; Panagis Galiatsatos; Laura M Paulin; Jerry A Krishnan; Christopher B Cooper; David J Couper; Richard E Kanner; Russell P Bowler; Eric A Hoffman; Alejandro P Comellas; Gerard J Criner; R Graham Barr; Fernando J Martinez; MeiLan K Han; Carlos H Martinez; Victor E Ortega; Trisha M Parekh; Stephanie A Christenson; Neeta Thakur; Aaron Baugh; Daniel C Belz; Sarath Raju; Amanda J Gassett; Joel D Kaufman; Nirupama Putcha; Nadia N Hansel

doi:10.1164/RCCM.202002-0253OC

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

Journal article

Open access

Peer reviewed

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

Chinedu O Ejike, Han Woo, Panagis Galiatsatos, Laura M Paulin, Jerry A Krishnan, Christopher B Cooper, David J Couper, Richard E Kanner, Russell P Bowler, Eric A Hoffman, …

American journal of respiratory and critical care medicine, Vol.203(8), pp.987-997

04/15/2021

DOI: 10.1164/RCCM.202002-0253OC

PMCID: PMC8048743

PMID: 33007162

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https://www.ncbi.nlm.nih.gov/pmc/articles/8048743View

Open Access

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.

Adult

African Americans - statistics & numerical data

Aged

Aged, 80 and over

Female

Health Status Disparities

Healthcare Disparities - statistics & numerical data

Humans

Male

Middle Aged

Outcome Assessment, Health Care - statistics & numerical data

Pulmonary Disease, Chronic Obstructive - physiopathology

Pulmonary Disease, Chronic Obstructive - therapy

Race Factors - statistics & numerical data

Smoking - adverse effects

Social Class

Socioeconomic Factors

Surveys and Questionnaires

Whites - statistics & numerical data

Details

Title: Subtitle: Contribution of Individual and Neighborhood Factors to Racial Disparities in Respiratory Outcomes
Creators: Chinedu O Ejike - Johns Hopkins University
Han Woo - Johns Hopkins University
Panagis Galiatsatos - Johns Hopkins University
Laura M Paulin - Dartmouth–Hitchcock Medical Center
Jerry A Krishnan - University of Illinois Chicago
Christopher B Cooper - University of California, Los Angeles
David J Couper - University of North Carolina at Chapel Hill
Richard E Kanner - University of Utah
Russell P Bowler - National Jewish Health
Eric A Hoffman - University of Iowa
Alejandro P Comellas - Roy J. and Lucille A. Carver College of Medicine
Gerard J Criner - Temple University Hospital
R Graham Barr - Columbia University Irving Medical Center
Fernando J Martinez - Cornell University
MeiLan K Han - University of Michigan
Carlos H Martinez - Division of Pulmonary and Critical Care, Oaklawn Hospital, Marshall, Michigan.
Victor E Ortega - Wake Forest University
Trisha M Parekh - University of Alabama at Birmingham
Stephanie A Christenson - University of California, San Francisco
Neeta Thakur - University of California, San Francisco
Aaron Baugh - University of California, San Francisco
Daniel C Belz - Johns Hopkins University
Sarath Raju - Johns Hopkins University
Amanda J Gassett - University of Washington
Joel D Kaufman - University of Washington
Nirupama Putcha - Johns Hopkins University
Nadia N Hansel - Johns Hopkins University
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.203(8), pp.987-997
DOI: 10.1164/RCCM.202002-0253OC
PMID: 33007162
PMCID: PMC8048743
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1535-4970
eISSN: 1535-4970
Grant note: HHSN268200900017C / NHLBI NIH HHS P30 ES005605 / NIEHS NIH HHS HHSN268200900019C / NHLBI NIH HHS HHSN268200900020C / NHLBI NIH HHS R01 ES023500 / NIEHS NIH HHS U01 HL137880 / NHLBI NIH HHS HHSN268200900015C / NHLBI NIH HHS HHSN268200900013C / NHLBI NIH HHS K23 HL153672 / NHLBI NIH HHS K24 HL137013 / NHLBI NIH HHS K23 ES025781 / NIEHS NIH HHS T32 HL007534 / NHLBI NIH HHS P50 MD010431 / NIMHD NIH HHS HHSN268200900016C / NHLBI NIH HHS HHSN268200900018C / NHLBI NIH HHS HHSN268200900014C / NHLBI NIH HHS K23 HL123778 / NHLBI NIH HHS K24 HL138188 / NHLBI NIH HHS
Language: English
Date published: 04/15/2021
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
Record Identifier: 9984318822202771

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