Abstract
Chronic lower respiratory disease (CLRD) is the fourth leading cause of death in the United States, which imposes a considerable burden on individuals, families, and societies. The association between county-level health disparity and CLRD outcomes in New York state needs investigation. To evaluate the associations of CLRD outcomes with county-level health disparities in New York state. In this cross-sectional study, CLRD age-adjusted hospitalization for 2016 and mortality rates from 2014 to 2016 were obtained from the New York state Community Health Indicator Reports provided by the New York state Department of Health. County Health Rankings were used to evaluate various health factors to provide a summary z score for each county representing the county health status and how that county ranks in the state. Data analysis was performed from November 2020 to March 2021. The main outcomes were age-adjusted hospitalization and mortality rates for CLRD. The z score was calculated from the County Health Rankings, which includes subindicators of health behaviors, clinical care, social and economic factors, and physical environment. Pearson r and linear regression models were estimated. During the study, 60 335 discharges were documented as CLRD hospitalizations in 2016 and 20 612 people died from CLRD from 2014 to 2016 in New York state. After adjusting for age, the CLRD hospitalization rate was 27.6 per 10 000 population, and the mortality rate was 28.9 per 100 000 population. Among 62 counties, 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). Mortality rates ranged from 17.4 per 100 000 population in Kings to 62.9 per 100 000 population in Allegany. County Health Rankings indicated Nassau had the lowest z score (the healthiest), at -1.17, but 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). A 1-point increase in health behaviors z score was associated with an increase of 41.4 deaths per 100 000 population (β = 41.42 [95% CI, 29.88 to 52.97]; P < .001). In this cross-sectional study, CLRD outcomes were significantly associated with county-level health disparities in New York state. These findings suggest that public health interventions and resources aimed at improving CLRD outcomes should be tailored and prioritized in health disadvantaged areas.
Highlights
Chronic lower respiratory disease (CLRD) is defined by the Centers for Disease Control and Prevention (CDC) and the World Health Organization as encompassing 4 major diseases: chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and asthma.[1-3]
During the study, 60 335 discharges were documented as CLRD hospitalizations in 2016 and 20 612 people died from CLRD from 2014 to 2016 in New York state
In this cross-sectional study, CLRD outcomes were significantly associated with county-level health disparities in New York state
Summary
Chronic lower respiratory disease (CLRD) is defined by the Centers for Disease Control and Prevention (CDC) and the World Health Organization as encompassing 4 major diseases: chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, and asthma.[1-3]. Even though several studies clearly indicated socioeconomic status (SES) and health disparities could contribute to CLRD outcomes at regional or national level, to our knowledge, no study has investigated the association between county-level health disparity and CLRD outcomes in New York state. We hypothesized that CLRD hospitalizations and mortality would be significantly correlated with overall county health status and county-level health indicators. Our aim was to examine and provide a general overview of the association between CLRD outcomes and health disparities in New York state
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