Journal article
Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease
American journal of respiratory and critical care medicine, Vol.204(5), pp.536-545
09/01/2021
DOI: 10.1164/rccm.202009-3721OC
PMCID: PMC8491265
PMID: 33971109
Abstract
Rationale: Racial residential segregation has been associated with worse health outcomes, but the link with chronic obstructive pulmonary disease (COPD) morbidity has not been established. Objectives: To investigate whether racial residential segregation is associated with COPD morbidity among urban Black adults with or at risk of COPD. Methods: 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. Measurements and Main Results: Among 515 Black participants, those residing in segregated neighborhoods (i.e., isolation index >0.6) had worse COPD Assessment Test score (b = 2.4; 95% confidence interval [CI], 0.7 to 4.0), dyspnea (modified Medical Research Council scale; b = 0.29; 95% CI, 0.10 to 0.47), quality of life (St. George's Respiratory Questionnaire; b = 6.1; 95% CI, 2.3 to 9.9), and cough and sputum (b = 0.8; 95% CI, 0.1 to 1.5); lower FEV1% predicted (b = 27.3; 95% CI, 210.9 to 23.6); higher rate of any and severe exacerbations; and higher percentage emphysema (b = 2.3; 95% CI, 0.7 to 3.9) and air trapping (b = 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, FEV1% predicted, percentage emphysema, and air trapping. Conclusions: 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.
Details
- Title: Subtitle
- Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease
- Creators
- Han Woo - Division of Pulmonary and Critical Care Medicine and.Emily P. Brigham - Division of Pulmonary and Critical Care Medicine and.Kassandra Allbright - Division of Pulmonary and Critical Care Medicine and.Chinedu Ejike - Division of Pulmonary and Critical Care Medicine and.Panagis Galiatsatos - Division of Pulmonary and Critical Care Medicine and.Miranda R. Jones - BloombergGabriela R. Oates - Division of Pediatric Pulmonary and Sleep Medicine and.Jerry A. Krishnan - University of Illinois at ChicagoChristopher B. Cooper - University of California, Los AngelesRichard E. Kanner - University of UtahRussell P. Bowler - National Jewish HealthEric A. Hoffman - University of IowaAlejandro P. Comellas - University of IowaGerard Criner - Temple University HospitalR. Graham Barr - Columbia University Irving Medical CenterFernando J. Martinez - Cornell UniversityMeiLan Han - University of Michigan–Ann ArborVictor E. Ortega - Wake Forest UniversityTrisha M. Parekh - University of Alabama at BirminghamStephanie Christenson - University of California, San FranciscoDaniel Belz - Division of Pulmonary and Critical Care Medicine and.Sarath Raju - Division of Pulmonary and Critical Care Medicine and.Amanda Gassett - University of WashingtonLaura M. Paulin - Dartmouth–Hitchcock Medical CenterNirupama Putcha - Division of Pulmonary and Critical Care Medicine and.Joel D. Kaufman - University of WashingtonNadia N. Hansel - Division of Pulmonary and Critical Care Medicine and.
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.204(5), pp.536-545
- DOI
- 10.1164/rccm.202009-3721OC
- PMID
- 33971109
- PMCID
- PMC8491265
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Language
- English
- Date published
- 09/01/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9984318780802771
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