A105-05 Changes in Asthma and COPD Hospitalizations After Moving From Disadvantaged Neighborhoods: A Difference-In-Differences Analysis

Rationale Adults with asthma and chronic obstructive pulmonary disease (COPD) who live in disadvantaged neighborhoods with higher environmental burden and social vulnerability experience worse disease severity and increased acute care utilization. However, little is known if changing the neighborhood environment can improve clinical outcomes. Therefore, in this national study, we sought to understand how moving from the most disadvantaged to the least disadvantaged neighborhoods changed asthma and COPD-related outcomes. Methods In this quasi-experimental difference-in-difference analysis, we used national 100% Medicare claims data between 2017 and 2019. Our study population was Medicare beneficiaries age ≥65 years with a diagnosis of asthma and/or COPD who moved in 2018, and our outcome was asthma/COPD-related hospitalizations. We first divided neighborhoods into deciles by their 2022 Environmental Justice Index (EJI), the first national, granular and comprehensive measure of neighborhood characteristics comprised of 17 environmental indicators (e.g., air pollution, built environment) and 14 social indicators (e.g., poverty, unemployment, poor housing conditions). We performed a difference-in-differences analysis to evaluate the change in hospitalizations in the year before (2017) and after (2019) beneficiaries moved (blank out period 2018), comparing changes among beneficiaries who moved from a neighborhood in the highest EJI decile to one in the lowest EJI decile to those who moved from highest to highest EJI decile (control group). Both the intervention and control groups included movers to account for unmeasured confounding that might be associated with moving. We fit a negative binomial regression model with county level random effects, adjusted for patient age, sex, race and ethnicity, and clinical comorbidities. Parallel trends were assessed. Results Our study included 2,860 beneficiaries who moved from a high EJI neighborhood (i.e. most environmentally burdened and socially vulnerable) to a low EJI neighborhood (mean age 78.2 years, 65.9% female), and 13,325 beneficiaries who moved between high EJI neighborhoods (mean age 76.0, 60.7% female). There was no significant difference in the hospitalization rates between beneficiaries who moved from a high to low EJI neighborhood compared to those who moved between high EJI neighborhoods (adjusted difference-in-difference rate ratio, 0.91 [95% CI, 0.67 to 1.25]). Conclusion Moving from environmentally and socially burdened neighborhoods was not associated with a significant change in hospitalizations due to asthma and COPD. Further research is needed to understand if moving is associated with changes in other clinical outcomes, such as emergency department visits, or among certain subgroups of patients.