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Environmental justice index and prevalence of asthma and COPD in US neighborhoods- a population-based study
Sumanth Khadke1, Vidhatri Khadke2, Ashish Kumar3
1Division of Cardiovascular Medicine, Department of Internal Medicine, Lahey Hospital & Medical Center, 41 Mall Road, Burlington, MA, USA.
Background:
The independent effects of social and environmental factors on asthma and chronic obstructive pulmonary disease (COPD) are well-documented, but less is known about their combined impact across US neighborhoods. This study aimed to determine the combined and individual associations of neighborhood-level social vulnerability and environmental burden with the prevalence of asthma and COPD.
Methods:
This cross-sectional study analyzed 71,677 US census tracts, linking the 2022 CDC Environmental Justice Index (EJI) rankings and its subcomponents (environmental burden module [EBM] and social vulnerability module [SVM]) to the 2023 CDC PLACES dataset. Multivariable quasi-Poisson regression with an offset function was used to compare covariate-adjusted risk ratios of health indicators across quartiles of neighborhood socio-environmental burden.
Findings:
Among the 71,677 neighborhoods studied, the median proportion of females was 50.90%. The median proportions of individuals aged 18 to 44, 45 to 64, and ≥65 were 30.6%, 26.7%, and 15.3%, respectively, with 22.6% of the Hispanic population. Asthma and COPD prevalence rates increased with increasing EJI and EBM quartiles. Neighborhoods with the highest socio-environmental burden (Q4 EJI) had significantly higher rates of asthma (RR:1.102, 95% CI: 1.087-1.117, p < 0.001) and COPD (RR:1.156, 95% CI:1.141-1.172, p < 0.001) compared to neighborhoods with the lowest burden (Q1 EJI), after adjusting for covariates. Similarly, neighborhoods with the highest environmental burden (Q4 EBM) had higher rates of asthma (RR: 1.091, 95% CI: 1.064-1.118, p < 0.001) and COPD (RR:1.099, 95% CI: 1.070-1.129, p < 0.001) compared with Q1 EBM, after adjusting for SVM and other covariates.
Interpretation:
A higher prevalence of obstructive lung disease is associated with neighborhoods experiencing high cumulative socio-environmental burden. Environmental burden showed an independent association with asthma and COPD prevalence, even after adjusting for social vulnerability and other factors.
Funding:
None.
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