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: %) 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: = 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.