142nd APHA Annual Meeting and Exposition

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302375
Epidemiology of asthma and chronic obstructive pulmonary disease (COPD) in Chicago: Assessing the presence of city- and neighborhood-level disparities

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 3:15 PM - 3:30 PM

Helen Margellos-Anast, MPH , Sinai Urban Health Institute, Sinai Health System, Chicago, IL
Steven Whitman, PhD , Sinai Urban Health Institute, Sinai Health System, Chicago, IL
Chronic lower respiratory disease (CLRD), which includes asthma and COPD, is the 3rd leading cause of death in the U.S.  While asthma disparities are well documented, the evidence regarding COPD is limited and that concerning local-level variation is virtually non-existent.  Given the burden COPD exerts, an assessment of local-level data to inform an appropriate public health response is imperative.

Three-year age-adjusted mortality, hospitalization, and emergency department (ED) rates for COPD and asthma were calculated on a Chicago- and neighborhood-level.  Rate Ratios and 95% confidence intervals were computed to assess disparities by race, gender, and geography.  Bivariate correlation analyses explored relationships between hospitalization and ED rates and zip code-level ecological variables.

In Chicago, significant disparities exist for both COPD and asthma, with non-Hispanic Black (NHB) people and those living in poorer neighborhoods being most affected.   NHB women have lower COPD mortality rates than non-Hispanic White (NHW) women; NHB men did not experience a similar mortality advantage.  NHB Chicagoans are significantly more likely to have utilized urgent health services for COPD than their NHW counterparts.  Disparities in mortality and health resource utilization are particularly pronounced for asthma, with NHB people being 5.4 times more likely to die of asthma and 9.0 times more likely to visit an ED  than  NHW people.  The correlation analysis reveals a strong and positive relationship between CLRD hospitalization and ED rates and the proportion of a zip code that is NHB (p<0.05). Geographic analysis confirms the most affected neighborhoods are predominantly NHB and poor.

Significant disparities exist for CLRD at the city and neighborhood level.  Examinations of national data alone mask the presence of such variations, which are vital in formulating a culturally appropriate response.

Learning Areas:

Assessment of individual and community needs for health education
Chronic disease management and prevention
Epidemiology

Learning Objectives:
Differentiate between national, Chicago, and local-level trends in COPD and asthma epidemiology. Describe disparities revealed by local-level analyses in COPD and asthma mortality, hospitalization and emergency department rates by race/ethnicity, income, gender and geography. Discuss the utility of local-level data in formulating culturally appropriate public health responses

Keyword(s): Asthma, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a Senior Epidemiologist and disparities researcher with SUHI for over 13 years, I have gained experience in researching and addressing health disparities, designing and evaluating health interventions, survey design, methodology and analysis, and in working with community members to best address health needs. I have published papers concerning overall health disparities in Chicago and the U.S., and specific to disparities in childhood obesity, asthma, and the health status of Deaf persons.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.