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Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease

  • Environmental Epidemiology (F Laden and J Hart, Section Editors)
  • Published:
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Abstract

Purpose of Review

Multiple respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), display significant socioeconomic and racial/ethnic disparities. The objective of this review is to evaluate the evidence supporting a link between disproportionate environmental exposures and these health disparities.

Recent Findings

Studies suggest that various co-occurring factors related to the home environment, neighborhood environment, non-modifiable individual factors, and individual behaviors and attributes can increase or modify the risk of adverse respiratory outcomes among socioeconomically disadvantaged and racially/ethnically diverse populations. Pollutants in the home environment, including particulate matter, nitrogen dioxide, and pesticides, are elevated among lower socioeconomic status populations and have been implicated in the development or exacerbation of respiratory-related conditions. Neighborhood crime and green space are socioeconomically patterned and linked with asthma outcomes through psychosocial pathways. Non-modifiable individual factors such as genetic predisposition cannot explain environmental health disparities but can increase susceptibility to air pollution and other stressors. Individual behaviors and attributes, including obesity and physical activity, contribute to worse outcomes among those with asthma or COPD.

Summary

The root causes of these multifactorial exposures are complex, but many likely stem from economic forces and racial/ethnic and economic segregation that influence the home environment, neighborhood environment, and access to healthy foods and consumer products. Critical research needs include investigations that characterize exposure to and health implications of numerous stressors simultaneously, both to guard against potential confounding in epidemiological investigations and to consider the cumulative impact of multiple elevated environmental exposures and sociodemographic stressors on health disparities.

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Acknowledgments

JL and PF were supported by the National Institute on Minority Health and Health Disparities (NIMHD) and the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH) [Award No. P50 MD010428]; the U.S. Environmental Protection Agency (EPA) [Award No. RD-836156]; and the NIEHS/NIH [Award No. R01 ES027816]. KB was supported by the NIEHS/NIH (T32 ES014562). NH was supported by the NIMHD and NIEHS (NIH) [Award No. P50 MD010431 and P50 ES018176]; the U.S. EPA [Award No. 83615001 and No. 83615201]; and the NIEHS/NIH [Award No. R01 ES022607 and R01 ES023500]. LQA was supported by a National Heart Lung and Blood Institute (NHLBI) Career Development Award (K01 HL138124).

This manuscript has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication.

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Authors and Affiliations

  1. Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118-2526, USA

    Jonathan I. Levy, M. Patricia Fabian & Komal Basra

  2. Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA

    Lesliam Quirós-Alcalá

  3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Lesliam Quirós-Alcalá & Nadia N. Hansel

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Correspondence to Jonathan I. Levy.

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Conflict of Interest

Jonathan I. Levy reports grants from National Institute on Minority Health and Health Disparities, grants from National Institute of Environmental Health Sciences, and grants from US Environmental Protection Agency, during the conduct of the study.

Lesliam Quirós-Alcalá reports grants from National Institutes of Health, during the conduct of the study.

M. Patricia Fabian reports grants from National Institutes of Health and grants from Environmental Protection Agency, during the conduct of the study.

Komal Basra reports grants from National Institutes of Health, during the conduct of the study.

Nadia N. Hansel reports grants from National Institute on Minority Health and Health Disparities, grants from National Institute of Environmental Health Sciences, and grants from US Environmental Protection Agency, during the conduct of the study; grants and personal fees from AstraZeneca, grants and personal fees from GSK, grants from Boehringer Ingelheim, grants from National Institutes of Health, and grants from COPD Foundation, outside the submitted work.

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Levy, J.I., Quirós-Alcalá, L., Fabian, M.P. et al. Established and Emerging Environmental Contributors to Disparities in Asthma and Chronic Obstructive Pulmonary Disease. Curr Epidemiol Rep 5, 114–124 (2018). https://doi.org/10.1007/s40471-018-0149-9

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