Built environment factors predictive of early rapid lung function decline in cystic fibrosis

Emrah Gecili; Cole Brokamp; Erika Rasnick; Pedro M. Afonso; Eleni Rosalina Andrinopoulou; Judith W. Dexheimer; John P. Clancy; Ruth H. Keogh; Yizhao Ni; Anushka Palipana; Teresa Pestian; Andrew Vancil; Grace C. Zhou; Weiji Su; Christopher Siracusa; Patrick Ryan; Rhonda D. Szczesniak

doi:10.1002/ppul.26352

Built environment factors predictive of early rapid lung function decline in cystic fibrosis

Emrah Gecili, Cole Brokamp, Erika Rasnick, Pedro M. Afonso, Eleni Rosalina Andrinopoulou, Judith W. Dexheimer, John P. Clancy, Ruth H. Keogh, Yizhao Ni, Anushka Palipana, Teresa Pestian, Andrew Vancil, Grace C. Zhou, Weiji Su, Christopher Siracusa, Patrick Ryan, Rhonda D. Szczesniak^*

^*Corresponding author for this work

Epidemiology

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

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Abstract

Background: The extent to which environmental exposures and community characteristics of the built environment collectively predict rapid lung function decline, during adolescence and early adulthood in cystic fibrosis (CF), has not been examined. Objective: To identify built environment characteristics predictive of rapid CF lung function decline. Methods: We performed a retrospective, single-center, longitudinal cohort study (n = 173 individuals with CF aged 6–20 years, 2012–2017). We used a stochastic model to predict lung function, measured as forced expiratory volume in 1 s (FEV₁) of % predicted. Traditional demographic/clinical characteristics were evaluated as predictors. Built environmental predictors included exposure to elemental carbon attributable to traffic sources (ECAT), neighborhood material deprivation (poverty, education, housing, and healthcare access), greenspace near the home, and residential drivetime to the CF center. Measurements and Main Results: The final model, which included ECAT, material deprivation index, and greenspace, alongside traditional demographic/clinical predictors, significantly improved fit and prediction, compared with only demographic/clinical predictors (Likelihood Ratio Test statistic: 26.78, p < 0.0001; the difference in Akaike Information Criterion: 15). An increase of 0.1 μg/m³ of ECAT was associated with 0.104% predicted/yr (95% confidence interval: 0.024, 0.183) more rapid decline. Although not statistically significant, material deprivation was similarly associated (0.1-unit increase corresponded to additional decline of 0.103% predicted/year [−0.113, 0.319]). High-risk regional areas of rapid decline and age-related heterogeneity were identified from prediction mapping. Conclusion: Traffic-related air pollution exposure is an important predictor of rapid pulmonary decline that, coupled with community-level material deprivation and routinely collected demographic/clinical characteristics, enhance CF prognostication and enable personalized environmental health interventions.

Original language	English
Pages (from-to)	1501-1513
Number of pages	13
Journal	Pediatric Pulmonology
Volume	58
Issue number	5
Early online date	12 Feb 2023
DOIs	https://doi.org/10.1002/ppul.26352
Publication status	Published - May 2023

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health under Grants R01 HL141286 and P30DK117467 and the Cystic Fibrosis Foundation under Grants GECILI20F0 and Naren19R0. The authors thank the care teams and patients at the Cystic Fibrosis Care Center within the Division of Pulmonary Medicine at Cincinnati Children's Hospital for data to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Cystic Fibrosis Foundation.

Funding Information:
This work was supported by the National Institutes of Health under Grants R01 HL141286 and P30DK117467 and the Cystic Fibrosis Foundation under Grants GECILI20F0 and Naren19R0. The authors thank the care teams and patients at the Cystic Fibrosis Care Center within the Division of Pulmonary Medicine at Cincinnati Children's Hospital for data to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Cystic Fibrosis Foundation.

Publisher Copyright:
© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.

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Pediatric Pulmonology - 2023 - Gecili - Built environment factors predictive of early rapid lung function decline in cysticFinal published version, 1.67 MBLicence: CC BY-NC-ND

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Gecili, E., Brokamp, C., Rasnick, E., Afonso, P. M., Andrinopoulou, E. R., Dexheimer, J. W., Clancy, J. P., Keogh, R. H., Ni, Y., Palipana, A., Pestian, T., Vancil, A., Zhou, G. C., Su, W., Siracusa, C., Ryan, P., & Szczesniak, R. D. (2023). Built environment factors predictive of early rapid lung function decline in cystic fibrosis. Pediatric Pulmonology, 58(5), 1501-1513. https://doi.org/10.1002/ppul.26352

@article{de40639a1bc547a8a1be46c19d6e53ca,

title = "Built environment factors predictive of early rapid lung function decline in cystic fibrosis",

abstract = "Background: The extent to which environmental exposures and community characteristics of the built environment collectively predict rapid lung function decline, during adolescence and early adulthood in cystic fibrosis (CF), has not been examined. Objective: To identify built environment characteristics predictive of rapid CF lung function decline. Methods: We performed a retrospective, single-center, longitudinal cohort study (n = 173 individuals with CF aged 6–20 years, 2012–2017). We used a stochastic model to predict lung function, measured as forced expiratory volume in 1 s (FEV1) of % predicted. Traditional demographic/clinical characteristics were evaluated as predictors. Built environmental predictors included exposure to elemental carbon attributable to traffic sources (ECAT), neighborhood material deprivation (poverty, education, housing, and healthcare access), greenspace near the home, and residential drivetime to the CF center. Measurements and Main Results: The final model, which included ECAT, material deprivation index, and greenspace, alongside traditional demographic/clinical predictors, significantly improved fit and prediction, compared with only demographic/clinical predictors (Likelihood Ratio Test statistic: 26.78, p < 0.0001; the difference in Akaike Information Criterion: 15). An increase of 0.1 μg/m3 of ECAT was associated with 0.104% predicted/yr (95% confidence interval: 0.024, 0.183) more rapid decline. Although not statistically significant, material deprivation was similarly associated (0.1-unit increase corresponded to additional decline of 0.103% predicted/year [−0.113, 0.319]). High-risk regional areas of rapid decline and age-related heterogeneity were identified from prediction mapping. Conclusion: Traffic-related air pollution exposure is an important predictor of rapid pulmonary decline that, coupled with community-level material deprivation and routinely collected demographic/clinical characteristics, enhance CF prognostication and enable personalized environmental health interventions.",

author = "Emrah Gecili and Cole Brokamp and Erika Rasnick and Afonso, {Pedro M.} and Andrinopoulou, {Eleni Rosalina} and Dexheimer, {Judith W.} and Clancy, {John P.} and Keogh, {Ruth H.} and Yizhao Ni and Anushka Palipana and Teresa Pestian and Andrew Vancil and Zhou, {Grace C.} and Weiji Su and Christopher Siracusa and Patrick Ryan and Szczesniak, {Rhonda D.}",

note = "Funding Information: This work was supported by the National Institutes of Health under Grants R01 HL141286 and P30DK117467 and the Cystic Fibrosis Foundation under Grants GECILI20F0 and Naren19R0. The authors thank the care teams and patients at the Cystic Fibrosis Care Center within the Division of Pulmonary Medicine at Cincinnati Children's Hospital for data to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Cystic Fibrosis Foundation. Funding Information: This work was supported by the National Institutes of Health under Grants R01 HL141286 and P30DK117467 and the Cystic Fibrosis Foundation under Grants GECILI20F0 and Naren19R0. The authors thank the care teams and patients at the Cystic Fibrosis Care Center within the Division of Pulmonary Medicine at Cincinnati Children's Hospital for data to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Cystic Fibrosis Foundation. Publisher Copyright: {\textcopyright} 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.",

year = "2023",

month = may,

doi = "10.1002/ppul.26352",

language = "English",

volume = "58",

pages = "1501--1513",

journal = "Pediatric Pulmonology",

issn = "8755-6863",

publisher = "John Wiley & Sons Inc.",

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}

Gecili, E, Brokamp, C, Rasnick, E, Afonso, PM , Andrinopoulou, ER, Dexheimer, JW, Clancy, JP, Keogh, RH, Ni, Y, Palipana, A, Pestian, T, Vancil, A, Zhou, GC, Su, W, Siracusa, C, Ryan, P & Szczesniak, RD 2023, 'Built environment factors predictive of early rapid lung function decline in cystic fibrosis', Pediatric Pulmonology, vol. 58, no. 5, pp. 1501-1513. https://doi.org/10.1002/ppul.26352

TY - JOUR

T1 - Built environment factors predictive of early rapid lung function decline in cystic fibrosis

AU - Gecili, Emrah

AU - Brokamp, Cole

AU - Rasnick, Erika

AU - Afonso, Pedro M.

AU - Andrinopoulou, Eleni Rosalina

AU - Dexheimer, Judith W.

AU - Clancy, John P.

AU - Keogh, Ruth H.

AU - Ni, Yizhao

AU - Palipana, Anushka

AU - Pestian, Teresa

AU - Vancil, Andrew

AU - Zhou, Grace C.

AU - Su, Weiji

AU - Siracusa, Christopher

AU - Ryan, Patrick

AU - Szczesniak, Rhonda D.

N1 - Funding Information: This work was supported by the National Institutes of Health under Grants R01 HL141286 and P30DK117467 and the Cystic Fibrosis Foundation under Grants GECILI20F0 and Naren19R0. The authors thank the care teams and patients at the Cystic Fibrosis Care Center within the Division of Pulmonary Medicine at Cincinnati Children's Hospital for data to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Cystic Fibrosis Foundation. Funding Information: This work was supported by the National Institutes of Health under Grants R01 HL141286 and P30DK117467 and the Cystic Fibrosis Foundation under Grants GECILI20F0 and Naren19R0. The authors thank the care teams and patients at the Cystic Fibrosis Care Center within the Division of Pulmonary Medicine at Cincinnati Children's Hospital for data to conduct this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Cystic Fibrosis Foundation. Publisher Copyright: © 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.

PY - 2023/5

Y1 - 2023/5

N2 - Background: The extent to which environmental exposures and community characteristics of the built environment collectively predict rapid lung function decline, during adolescence and early adulthood in cystic fibrosis (CF), has not been examined. Objective: To identify built environment characteristics predictive of rapid CF lung function decline. Methods: We performed a retrospective, single-center, longitudinal cohort study (n = 173 individuals with CF aged 6–20 years, 2012–2017). We used a stochastic model to predict lung function, measured as forced expiratory volume in 1 s (FEV1) of % predicted. Traditional demographic/clinical characteristics were evaluated as predictors. Built environmental predictors included exposure to elemental carbon attributable to traffic sources (ECAT), neighborhood material deprivation (poverty, education, housing, and healthcare access), greenspace near the home, and residential drivetime to the CF center. Measurements and Main Results: The final model, which included ECAT, material deprivation index, and greenspace, alongside traditional demographic/clinical predictors, significantly improved fit and prediction, compared with only demographic/clinical predictors (Likelihood Ratio Test statistic: 26.78, p < 0.0001; the difference in Akaike Information Criterion: 15). An increase of 0.1 μg/m3 of ECAT was associated with 0.104% predicted/yr (95% confidence interval: 0.024, 0.183) more rapid decline. Although not statistically significant, material deprivation was similarly associated (0.1-unit increase corresponded to additional decline of 0.103% predicted/year [−0.113, 0.319]). High-risk regional areas of rapid decline and age-related heterogeneity were identified from prediction mapping. Conclusion: Traffic-related air pollution exposure is an important predictor of rapid pulmonary decline that, coupled with community-level material deprivation and routinely collected demographic/clinical characteristics, enhance CF prognostication and enable personalized environmental health interventions.

AB - Background: The extent to which environmental exposures and community characteristics of the built environment collectively predict rapid lung function decline, during adolescence and early adulthood in cystic fibrosis (CF), has not been examined. Objective: To identify built environment characteristics predictive of rapid CF lung function decline. Methods: We performed a retrospective, single-center, longitudinal cohort study (n = 173 individuals with CF aged 6–20 years, 2012–2017). We used a stochastic model to predict lung function, measured as forced expiratory volume in 1 s (FEV1) of % predicted. Traditional demographic/clinical characteristics were evaluated as predictors. Built environmental predictors included exposure to elemental carbon attributable to traffic sources (ECAT), neighborhood material deprivation (poverty, education, housing, and healthcare access), greenspace near the home, and residential drivetime to the CF center. Measurements and Main Results: The final model, which included ECAT, material deprivation index, and greenspace, alongside traditional demographic/clinical predictors, significantly improved fit and prediction, compared with only demographic/clinical predictors (Likelihood Ratio Test statistic: 26.78, p < 0.0001; the difference in Akaike Information Criterion: 15). An increase of 0.1 μg/m3 of ECAT was associated with 0.104% predicted/yr (95% confidence interval: 0.024, 0.183) more rapid decline. Although not statistically significant, material deprivation was similarly associated (0.1-unit increase corresponded to additional decline of 0.103% predicted/year [−0.113, 0.319]). High-risk regional areas of rapid decline and age-related heterogeneity were identified from prediction mapping. Conclusion: Traffic-related air pollution exposure is an important predictor of rapid pulmonary decline that, coupled with community-level material deprivation and routinely collected demographic/clinical characteristics, enhance CF prognostication and enable personalized environmental health interventions.

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U2 - 10.1002/ppul.26352

DO - 10.1002/ppul.26352

M3 - Article

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AN - SCOPUS:85148864230

SN - 8755-6863

VL - 58

SP - 1501

EP - 1513

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

IS - 5

ER -

Built environment factors predictive of early rapid lung function decline in cystic fibrosis

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