Chronic Lower Respiratory Disease Associated with Health Disparities in New York

Investigators recorded “remarkable variation” in CLRD hospitalization and mortality rates in 62 counties in New York state.

A new cross-sectional study from New York found that outcomes for chronic lower respiratory disease (CLRD) were significantly associated with county-level health disparities in the state.

In 2019, the Centers for Disease Control and Prevention (CDC) reported that CLRD had resulted in 47.8 deaths per 100,000 population, making it the fourth leading cause of death.

With their study, Yu-Che Lee, MD, MPH, Department of Medicine, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, and fellow investigators examined and provided an overview of the association between CLRD outcomes and health disparities in New York state.

The Methods

For the present study, investigators utilized CLRD age-adjusted hospitalization rates per 10,000 population for 2016 and mortality rates per 100,000 population for 2014 to 2016 from the New York state Community Health Indicator Reports, which were provided by the New York State Department of Health.

Additionally, County Health Rankings were used to evaluate a myriad of health factors to provide a summary z score for each county representing the county health status and how that county ranks in the state.

The county overall health factors rankings were calculated based on a weighted sum of z scores for each health factor in 4 categories, including 30% for health behaviors (tobacco use, diet and exercise, alcohol and drug use, and sexual activity), 20% for clinical care ( access to care and quality of care), 40% for social and economic factors (education, employment, income, family and social support, and community safety), and 10% for physical environment ( air and water quality, housing, and transit).

From there, the team calculated the correlations between county-level health factors z scores and CLRD hospitalization and mortality rates using Pearson r.

Univariable (UVA) and multivariable linear regression analyses (MVA) were used to determine the associations between county-level health factors z score and CLRD hospitalization and mortality rates, any variables reported in UVA as significantly associated with CLRD outcomes or were strongly correlated in the preliminary analyses (Pearson r > 0.3 or r < −0.3) were then included in the multivariable linear regression model.

The Findings

Over the course of the study, the team noted 60,335 discharges that were documented as CLRD hospitalizations in 2016, as well as 20,612 CLRD-related deaths that occurred from 2014 to 2016 in New York state.

After adjusting for age, the CLRD hospitalization rate was reported as 27.6 per 10,000 population, with the mortality rate being 28.9 per 100,000 population.

Among the 62 counties included in the study, Bronx had the highest hospitalization rate (64.7 per 10,000 population), whereas Hamilton had the lowest hospitalization rate (6.6 per 10 000 population).

Data form the County Health Rankings indicated that the country of Nassau had the lowest z score at −1.17, while the Bronx had the highest z score (the least healthy), at 1.43, for overall health factors in 2018. An increase of 1 point in social and economic factors z score was associated with an increase of 17.6 hospitalizations per 10 000 population (β = 17.61 [95% CI, 10.36 to 24.87]; P < .001).

“CLRD outcomes were significantly associated with county-level health disparities,” the team wrote. “These findings suggested that public health interventions and resources aimed at improving CLRD outcomes should be tailored and prioritized in health disadvantaged areas,” the team wrote.

The study, “Association of Chronic Lower Respiratory Disease with County Health Disparities in New York State,” was published online in JAMA Open Network.