American Thoracic Society International Conference

American Thoracic Society International Conference

Source:

Schuyler AJ, et al. Residential and occupational exposures: Where we live, work and breathe. Presented at: American Thoracic Society International Conference; May 14-19, 2021 (virtual meeting).

Disclosures: Healio could not confirm relevant financial disclosures at the time of publication.
June 01, 2021
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Residence in redlined neighborhoods linked with lower lung function

Source:

Schuyler AJ, et al. Residential and occupational exposures: Where we live, work and breathe. Presented at: American Thoracic Society International Conference; May 14-19, 2021 (virtual meeting).

Disclosures: Healio could not confirm relevant financial disclosures at the time of publication.
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Adults with asthma living in neighborhoods that were deprioritized for mortgage investments in the 1930s, or redlined, had worse lung function than those living in non-redlined areas, researchers reported.

Redlining is a form of institutional racism and discriminatory mortgage lending practice enacted by the Home Owners’ Loan Corp. in more than 200 U.S. cities during the New Deal Era that resulted in racialized economic deprivation and segregation, according to a press release issued by the American Thoracic Society.

Asthma Blocks
Source: Adobe Stock.

“Black communities were mostly completely demarked in red or redlined as a result of this racist practice,” Alexander J. Schuyler, MD/PhD candidate at the University of Pittsburgh School of Medicine, said during presentation of the study during the American Thoracic Society International Conference.

Schuyler and Sally Wenzel, MD, director of the Asthma and Environmental Lung Health Institute at University of Pittsburgh Medical Center, conducted a cross-sectional study to examine the impact of residence in historically redlined neighborhoods on lung function and asthma outcomes in 326 adults with asthma in the Pittsburgh region. The researchers analyzed lung health by ZIP codes according to the Home Owners’ Loan Corp. designation on an original redlining map of Pittsburgh. Most of those in the study lived in yellow/red ZIP codes (n = 256), which indicated more redlining, and fewer lived in blue/green ZIP codes (n = 70), which indicated less redlining, according to the presentation. All participants had baseline spirometry performed and completed questionnaires.

Researchers observed higher proportions of Black (41.4%), female (75.8%) and older patients with asthma (mean age, 46.5 years) in yellow/red redlined ZIP codes compared with blue/green redlined ZIP codes (15.7% Black; 62.9% women; mean age, 40.3 years).

Those living in yellow/red ZIP codes had lower percent predicted mean FEV1 (85% vs. 93%; P < .001) and FVC (91% vs. 99%; P < .001) in adjusted and unadjusted models. In addition, FEV1/FVC ratio was lower among those living in yellow/red ZIP codes (mean, 0.75 vs. 0.78; P = .03).

The associations between FEV1, FVC and FEV1/FVC ratio remained after covariate adjustments.

Researchers also found evidence of more severe and uncontrolled asthma, along with increased prevalence of comorbidities, including hypertension (23.5% vs. 13%; P = .06), diabetes (10.3% vs. 1.4%; P = .02), GERD (32.9% vs. 29.4%; P = .58) and depression/anxiety (63% vs. 47.8%; P = .02), among those with asthma living in yellow/red ZIP codes compared with those living in blue/green ZIP codes.

The researchers extended this study to include 1,034 patients, with 81 living in yellow neighborhoods, 377 living in red neighborhoods, 400 living in blue neighborhoods and 176 living in green neighborhoods. The trend of more poorly controlled asthma among patients living in historically yellow/red ZIP codes persisted (P = .003), according to Schuyler.

“These data extend the knowledge regarding the impact of historic redlining on lung health and greatly contribute context to the otherwise scant literature,” Schuyler said. “We propose the use of a lower limit of normal for spirometry that does not include a race correction to help reduce bias in patient care.”

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