Daniel C Belz1, Han Woo2, Nirupama Putcha3, Laura M Paulin4, Kirsten Koehler5, Ashraf Fawzy6, Neil E Alexis7, R Graham Barr8, Alejandro P Comellas9, Christopher B Cooper10, David Couper11, Mark Dransfield12, Amanda J Gassett13, MeiLan Han14, Eric A Hoffman15, Richard E Kanner16, Jerry A Krishnan17, Fernando J Martinez18, Robert Paine19, Roger D Peng20, Stephen Peters21, Cheryl S Pirozzi22, Prescott G Woodruff23, Joel D Kaufman24, Nadia N Hansel25. 1. Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA. Electronic address: Dbelz2@jhmi.edu. 2. Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA. Electronic address: Hwoo4@jhu.edu. 3. Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA. Electronic address: Nputcha1@jhmi.edu. 4. Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Pulmonary 5C Ste, Lebanon, NH 03756, USA. Electronic address: laura.m.paulin@hitchcock.org. 5. Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: kkoehle1@jhu.edu. 6. Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA. Electronic address: Afawzy1@jhmi.edu. 7. University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Electronic address: neil_alexis@med.unc.edu. 8. Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA. Electronic address: rgb9@cumc.columbia.edu. 9. University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. Electronic address: alejandro-comellas@uiowa.edu. 10. University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. Electronic address: ccooper@mednet.ucla.edu. 11. University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. Electronic address: david_couper@unc.edu. 12. University of Alabama, Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA. Electronic address: mdransfield@uabmc.edu. 13. University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA. Electronic address: agassett@uw.edu. 14. University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA. Electronic address: mrking@med.umich.edu. 15. University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. Electronic address: eric-hoffman@uiowa.edu. 16. University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA. Electronic address: richard.kanner@hsc.utah.edu. 17. University of Illinois at Chicago, 1853 West Polk Street, Chicago, IL 60612, USA. Electronic address: jakris@uic.edu. 18. Weill Cornell Medicine, 300 York Ave, New York, NY 10065, USA. Electronic address: fjm2003@med.cornell.edu. 19. University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA. Electronic address: robert.paine@hsc.utah.edu. 20. Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: rdpeng@jhu.edu. 21. Wake Forest University, 475 Vine St, Winston-Salem, NC 27101, USA. Electronic address: sppeters@wakehealth.edu. 22. University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA. Electronic address: cheryl.pirozzi@hsc.utah.edu. 23. University of California, San Francisco, 513 Parnassus Ave, HSE, San Francisco, CA 94143, USA. Electronic address: prescott.woodruff@ucsf.edu. 24. University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA. Electronic address: joelk@uw.edu. 25. Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA. Electronic address: Nhansel1@jhmi.edu.
Abstract
BACKGROUND: Neighborhood poverty has been associated with poor health outcomes. Previous studies have also identified adverse respiratory effects of long-term ambient ozone. Factors associated with neighborhood poverty may accentuate the adverse impact of ozone on respiratory health. OBJECTIVES: To evaluate whether neighborhood poverty modifies the association between ambient ozone exposure and respiratory morbidity including symptoms, exacerbation risk, and radiologic parameters, among participants of the SPIROMICS AIR cohort study. METHODS: Spatiotemporal models incorporating cohort-specific monitoring estimated 10-year average outdoor ozone concentrations at participants' homes. Adjusted regression models were used to determine the association of ozone exposure with respiratory outcomes, accounting for demographic factors, education, individual income, body mass index (BMI), and study site. Neighborhood poverty rate was defined by percentage of families living below federal poverty level per census tract. Interaction terms for neighborhood poverty rate with ozone were included in covariate-adjusted models to evaluate for effect modification. RESULTS: 1874 participants were included in the analysis, with mean (± SD) age 64 (± 8.8) years and FEV1 (forced expiratory volume in one second) 74.7% (±25.8) predicted. Participants resided in neighborhoods with mean poverty rate of 9.9% (±10.3) of families below the federal poverty level and mean 10-year ambient ozone concentration of 24.7 (±5.2) ppb. There was an interaction between neighborhood poverty rate and ozone concentration for numerous respiratory outcomes, including COPD Assessment Test score, modified Medical Research Council Dyspnea Scale, six-minute walk test, and odds of COPD exacerbation in the year prior to enrollment, such that adverse effects of ozone were greater among participants in higher poverty neighborhoods. CONCLUSION: Individuals with COPD in high poverty neighborhoods have higher susceptibility to adverse respiratory effects of ambient ozone exposure, after adjusting for individual factors. These findings highlight the interaction between exposures associated with poverty and their effect on respiratory health.
BACKGROUND: Neighborhood poverty has been associated with poor health outcomes. Previous studies have also identified adverse respiratory effects of long-term ambient ozone. Factors associated with neighborhood poverty may accentuate the adverse impact of ozone on respiratory health. OBJECTIVES: To evaluate whether neighborhood poverty modifies the association between ambient ozone exposure and respiratory morbidity including symptoms, exacerbation risk, and radiologic parameters, among participants of the SPIROMICS AIR cohort study. METHODS: Spatiotemporal models incorporating cohort-specific monitoring estimated 10-year average outdoor ozone concentrations at participants' homes. Adjusted regression models were used to determine the association of ozone exposure with respiratory outcomes, accounting for demographic factors, education, individual income, body mass index (BMI), and study site. Neighborhood poverty rate was defined by percentage of families living below federal poverty level per census tract. Interaction terms for neighborhood poverty rate with ozone were included in covariate-adjusted models to evaluate for effect modification. RESULTS: 1874 participants were included in the analysis, with mean (± SD) age 64 (± 8.8) years and FEV1 (forced expiratory volume in one second) 74.7% (±25.8) predicted. Participants resided in neighborhoods with mean poverty rate of 9.9% (±10.3) of families below the federal poverty level and mean 10-year ambient ozone concentration of 24.7 (±5.2) ppb. There was an interaction between neighborhood poverty rate and ozone concentration for numerous respiratory outcomes, including COPD Assessment Test score, modified Medical Research Council Dyspnea Scale, six-minute walk test, and odds of COPD exacerbation in the year prior to enrollment, such that adverse effects of ozone were greater among participants in higher poverty neighborhoods. CONCLUSION: Individuals with COPD in high poverty neighborhoods have higher susceptibility to adverse respiratory effects of ambient ozone exposure, after adjusting for individual factors. These findings highlight the interaction between exposures associated with poverty and their effect on respiratory health.
Authors: Murray M Finkelstein; Michael Jerrett; Patrick DeLuca; Norm Finkelstein; Dave K Verma; Kenneth Chapman; Malcolm R Sears Journal: CMAJ Date: 2003-09-02 Impact factor: 8.262
Authors: Meng Wang; Carrie Pistenmaa Aaron; Jaime Madrigano; Eric A Hoffman; Elsa Angelini; Jie Yang; Andrew Laine; Thomas M Vetterli; Patrick L Kinney; Paul D Sampson; Lianne E Sheppard; Adam A Szpiro; Sara D Adar; Kipruto Kirwa; Benjamin Smith; David J Lederer; Ana V Diez-Roux; Sverre Vedal; Joel D Kaufman; R Graham Barr Journal: JAMA Date: 2019-08-13 Impact factor: 56.272
Authors: Woo Jin Kim; Edwin K Silverman; Eric Hoffman; Gerard J Criner; Zab Mosenifar; Frank C Sciurba; Barry J Make; Vincent Carey; Raúl San José Estépar; Alejandro Diaz; John J Reilly; Fernando J Martinez; George R Washko Journal: Chest Date: 2009-05-01 Impact factor: 9.410
Authors: Nirupama Putcha; Ashraf Fawzy; Elizabeth C Matsui; Mark C Liu; Russ P Bowler; Prescott G Woodruff; Wanda K O'Neal; Alejandro P Comellas; MeiLan K Han; Mark T Dransfield; J Michael Wells; Njira Lugogo; Li Gao; C Conover Talbot; Eric A Hoffman; Christopher B Cooper; Laura M Paulin; Richard E Kanner; Gerard Criner; Victor E Ortega; R Graham Barr; Jerry A Krishnan; Fernando J Martinez; M Bradley Drummond; Robert A Wise; Gregory B Diette; Craig P Hersh; Nadia N Hansel Journal: Chest Date: 2020-05-23 Impact factor: 10.262
Authors: Cameron H Flayer; Moyar Q Ge; Jin W Hwang; Blerina Kokalari; Imre G Redai; Zhilong Jiang; Angela Haczku Journal: Front Immunol Date: 2019-09-13 Impact factor: 7.561