ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Residence in Redlined Neighborhoods Is Associated with Lower Lung Function in Asthmatic Adults
Session Title
TP61 - TP061 RESIDENTIAL AND OCCUPATIONAL EXPOSURES: WHERE WE LIVE, WORK, AND BREATHE
Abstract
A3028 - Residence in Redlined Neighborhoods Is Associated with Lower Lung Function in Asthmatic Adults
Author Block: A. J. Schuyler1, S. E. Wenzel2; 1Environmental & Occupational Health, University of Pittsburgh, Pittsburgh, PA, United States, 2Professor of Med PACCM, Univ of Pittsburgh Med Ctr, Pittsburgh, PA, United States.
Rationale: Redlining is discriminatory mortgage lending practice enacted by the Home Owners’ Loan Corporation (HOLC) and also a form of institutional racism that provides a historic and geographically validated mechanism for the imbalanced distribution of community and environmental risk factors for asthma. Spirometry is an important tool for asthma diagnosis/management. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are commonly adjusted for race, age, sex, and height in clinic and represented as %predicted values. Race, however, is a social construct. Some consider the race-based adjustment of spirometric values to perpetuate racism. Moreover, the impact of institutional racism on asthma outcomes remains poorly understood.
Methods: For this cross-sectional study, local asthmatic adults living in “more” (yellow/red) and “less” (blue/green) redlined zip codes according to HOLC designation on an original redlining map of Pittsburgh were identified through The University of Pittsburgh Asthma Institute@UPMC registry. Participants consented to baseline spirometry and questionnaires. Parametric tests were performed for intergroup comparisons. Lung function was adjusted for smoking history and co-variates related to the clinical adjustment/calculation of spirometric values by multivariate linear regression.
Results: “More” versus “less” redlined zip codes included a higher proportion of Black, female, and older asthma patients [Table 1]. Residence in “more” redlined zip codes was associated with lower FEV1 [adjusted/%predicted mean (SEM): 85% (1.2%) vs. 93% (1.8%), %difference=8.6%, p<0.001; unadjusted/L mean (SEM): 2.6L (0.054) vs. 3.2L (0.088), %difference=19%, p<0.001] and FVC [adjusted/%predicted mean (SEM): 91% (1.2%) vs. 99% (1.6%), %difference=8.1%, p<0.001; unadjusted/L mean (SEM): 3.5L (0.066) vs. 4.1L (0.12), %difference=15%, p<0.001]. The FEV1/FVC was lower as well [mean (SEM): 0.75 (0.012) vs. 0.78 (0.067), p=0.03]. Importantly, the relationships of FEV1 (L) [beta=0.13, p=0.003], FVC (L) [beta=0.10, p=0.03], and the FEV1/FVC ratio [beta=0.015, p=0.03] with redlining remained following adjustment for co-variates (age, sex, height, weight, smoking, race). Despite no difference in life-threatening asthma episodes, there was evidence for more severe/uncontrolled asthma with an increased prevalence of current co-morbidities in asthmatic adults living in “more” versus “less” redlined zip codes, independent of self-identified race [Table 1].
Conclusions: Residence in redlined communities could have a lasting impact on lung function and asthma outcomes. Caution should be given when using race-based adjustments of spirometric values as they may underestimate disease in adults living in communities damaged by racism. The larger %differences for non-adjusted FEV1 and FVC indicate that race-based adjustment of spirometric values may overcorrect for lung function in Black adults.
Author Block: A. J. Schuyler1, S. E. Wenzel2; 1Environmental & Occupational Health, University of Pittsburgh, Pittsburgh, PA, United States, 2Professor of Med PACCM, Univ of Pittsburgh Med Ctr, Pittsburgh, PA, United States.
Rationale: Redlining is discriminatory mortgage lending practice enacted by the Home Owners’ Loan Corporation (HOLC) and also a form of institutional racism that provides a historic and geographically validated mechanism for the imbalanced distribution of community and environmental risk factors for asthma. Spirometry is an important tool for asthma diagnosis/management. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are commonly adjusted for race, age, sex, and height in clinic and represented as %predicted values. Race, however, is a social construct. Some consider the race-based adjustment of spirometric values to perpetuate racism. Moreover, the impact of institutional racism on asthma outcomes remains poorly understood.
Methods: For this cross-sectional study, local asthmatic adults living in “more” (yellow/red) and “less” (blue/green) redlined zip codes according to HOLC designation on an original redlining map of Pittsburgh were identified through The University of Pittsburgh Asthma Institute@UPMC registry. Participants consented to baseline spirometry and questionnaires. Parametric tests were performed for intergroup comparisons. Lung function was adjusted for smoking history and co-variates related to the clinical adjustment/calculation of spirometric values by multivariate linear regression.
Results: “More” versus “less” redlined zip codes included a higher proportion of Black, female, and older asthma patients [Table 1]. Residence in “more” redlined zip codes was associated with lower FEV1 [adjusted/%predicted mean (SEM): 85% (1.2%) vs. 93% (1.8%), %difference=8.6%, p<0.001; unadjusted/L mean (SEM): 2.6L (0.054) vs. 3.2L (0.088), %difference=19%, p<0.001] and FVC [adjusted/%predicted mean (SEM): 91% (1.2%) vs. 99% (1.6%), %difference=8.1%, p<0.001; unadjusted/L mean (SEM): 3.5L (0.066) vs. 4.1L (0.12), %difference=15%, p<0.001]. The FEV1/FVC was lower as well [mean (SEM): 0.75 (0.012) vs. 0.78 (0.067), p=0.03]. Importantly, the relationships of FEV1 (L) [beta=0.13, p=0.003], FVC (L) [beta=0.10, p=0.03], and the FEV1/FVC ratio [beta=0.015, p=0.03] with redlining remained following adjustment for co-variates (age, sex, height, weight, smoking, race). Despite no difference in life-threatening asthma episodes, there was evidence for more severe/uncontrolled asthma with an increased prevalence of current co-morbidities in asthmatic adults living in “more” versus “less” redlined zip codes, independent of self-identified race [Table 1].
Conclusions: Residence in redlined communities could have a lasting impact on lung function and asthma outcomes. Caution should be given when using race-based adjustments of spirometric values as they may underestimate disease in adults living in communities damaged by racism. The larger %differences for non-adjusted FEV1 and FVC indicate that race-based adjustment of spirometric values may overcorrect for lung function in Black adults.
