TY - JOUR
T1 - Environmental justice index and prevalence of asthma and COPD in US neighborhoods- a population-based study
AU - Khadke, Sumanth
AU - Khadke, Vidhatri
AU - Kumar, Ashish
AU - Makwana, Bhargav
AU - Dani, Sourbha S.
AU - Al-Kindi, Sadeer
AU - Rajagopalan, Sanjay
AU - Kong, Yixin
AU - Nasir, Khurram
AU - Adamkiewicz, Gary
AU - Nohria, Anju
AU - Liesching, Timothy N.
AU - Ganatra, Sarju
AU - Pinto-Plata, Victor
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/9
Y1 - 2025/9
N2 - 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.
AB - 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.
KW - Asthma and COPD
KW - Environmental burden index
KW - Environmental justice index (EJI)
KW - Social determinants of health (SDOH)
KW - Social vulnerability index
UR - https://www.scopus.com/pages/publications/105012269709
UR - https://www.scopus.com/inward/citedby.url?scp=105012269709&partnerID=8YFLogxK
U2 - 10.1016/j.lana.2025.101195
DO - 10.1016/j.lana.2025.101195
M3 - Article
AN - SCOPUS:105012269709
SN - 2667-193X
VL - 49
JO - The Lancet Regional Health - Americas
JF - The Lancet Regional Health - Americas
M1 - 101195
ER -