Contribution of social and environmental exposures to lung function decline in chronic obstructive pulmonary disease: longitudinal analysis of electronic medical records data

Background: There is a paucity of knowledge regarding the joint and cumulative effects of multiple exposures from the physical, built, and social environments for chronic obstructive pulmonary disease (COPD) outcomes. Objectives: We assessed the separate and joint contributions of such factors for initial lung function and annual rate of change in a clinical cohort of patients with COPD. Design: Retrospective cohort study using electronic medical records. Methods: Data on individuals with an ICD-10 diagnosis of COPD were extracted from the University of Alabama at Birmingham Health System (2010–2020). Analyses were restricted to those who met spirometric criteria for a COPD diagnosis (FEV1/FVC < 0.7). The predicted FEV1 values (FEV1%) were calculated using 2022 GLI race-neutral equations. The earliest residential address during the study period was geocoded and linked to neighborhood characteristics at the Census tract level, including social vulnerability, environmental burden, walkability, residential segregation, rurality, and food access. Analyses adjusted for age, sex, race/ethnicity, marital status, smoking status, obesity, and comorbidities. Results: The analytic sample included 5652 patients. Social and environmental exposures differed by race (p < 0.001), with Black patients living in more urban and segregated environments with worse exposures. Adverse exposures were significantly associated with lower baseline FEV1%: overall environmental justice score, −11.43%; overall social vulnerability score, −12.29%; neighborhood socioeconomic status, −11.96%; residential segregation, −9.44%. Most associations remained significant after adjusting for patient demographic and clinical characteristics. When the multiple aspects of the environment were considered simultaneously, the dominant factor for baseline FEV1% was the overall social vulnerability (−12.31%, p < 0.001 unadjusted; −9.96%, p < 0.001 adjusted). Residence in a food desert was negatively associated with the annual rate of FEV1% decline (−0.41% unadjusted, p = 0.004; −0.39% adjusted, p = 0.009). Conclusion: Aspects of the physical, built, and social environments affect COPD outcomes. Findings can be used in risk prediction models and for the development of tools that incorporate such exposures at the point of care for individualized disease management.