The role of neighbourhood-level sociodemographic and socioeconomic characteristics on the physical activity of people with COPD

Abstract

Background: Physical activity is crucial in slowing COPD progression and reducing mortality, yet the influence of the neighbourhood's sociodemographic and socioeconomic environment on it remains unexplored. Our aim is to assess the relationship between these neighbourhood characteristics and physical activity in people with COPD.

Methods: We analysed cross-sectional data from 407 COPD participants from primary care and hospitals of five Catalan municipalities. We obtained neighbourhood percentages of sociodemographic (older adults and non-EU15 immigrants) and socioeconomic (illiteracy, unemployment and households in poor-conditioned buildings) characteristics from the Spanish Urban Vulnerability Atlas. Over 1 week, we tracked steps per day, time spent in physical activity of any intensity, moderate-to-vigorous physical activity (MVPA) and sedentary time using an activity monitor.

Results: After adjusting for age, sex, marital status, social class, road traffic noise levels and PM_2.5 in multivariable linear regression models, each 10% increase in the neighbourhood percentage of older adults was associated with 922 (95% CI: 84-1759) more steps per day and 11 (1 to 20) more minutes per day in MVPA. Each 10% increase in the neighbourhood percentage of non-EU15 immigrants was associated with fewer steps per day (-332; 95% CI: -647 to -16), fewer minutes per day in physical activity of any intensity (-5; 95% CI: -11 to 0) and fewer minutes per day in MVPA (-5; 95% CI: -7 to 0). No associations were found between neighbourhood socioeconomic characteristics and physical activity.

Conclusion: A neighbourhood's percentages of older adults and non-EU15 immigrants are associated with physical activity of COPD patients.

FIGURE 1

Distribution of neighbourhood-level sociodemographic and socioeconomic characteristics across the recruitment centres. Box central line and whiskers indicate median and IQR. Sample sizes for each recruitment centre: Badalona (n=28), Barcelona Clinic (n=79), Barcelona Mar (n=108), Mataró (n=73), Viladecans/Gavà (n=119).

FIGURE 2

Adjusted associations between neighbourhood-level sociodemographic and socioeconomic characteristics and objective physical activity in COPD patients in the overall sample and stratified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity levels (GOLD I–II and GOLD III–IV). Boxes and error bars indicate the adjusted regression coefficients and 95% confidence intervals (95% CI) per 10% increase in the neighbourhood-level characteristics. Models included all neighbourhood-level characteristics and age, sex, social class, marital status, road traffic noise levels and PM_2.5 as covariates. See all numbers and p-values in table 2. PA: physical activity; MVPA: moderate-to-vigorous physical activity; PM_2.5: particles with a 50% cut-off aerodynamic diameter of 2.5 µm. *: p-for-interaction <0.05.

FIGURE 3

Adjusted associations between neighbourhood characteristics and objective physical activity in COPD patients in the main analysis and including self-reported difficulty with physical activity and neighbourhood crime perception as additional covariates. Boxes and error bars indicate the adjusted regression coefficients and 95% confidence intervals (95% CI) per 10% increase in the neighbourhood-level characteristics. Models included all neighbourhood-level characteristics and age, sex, social class, marital status, road traffic noise levels and PM_2.5 as covariates. See all numbers and p-values in supplementary table S1. PA: physical activity; MVPA: moderate-to-vigorous physical activity; PM_2.5: particles with a 50% cut-off aerodynamic diameter of 2.5 µm.

FIGURE 4

Adjusted associations between neighbourhood characteristics and objective physical activity in COPD patients in the main analysis and sensitivity analyses using mixed models with recruitment centre as a random effect and excluding extreme values in exposure variables. Boxes and error bars indicate the adjusted regression coefficients and 95% confidence intervals (95% CI) per 10% increase in the neighbourhood-level characteristics. Models included all neighbourhood-level characteristics and age, sex, social class, marital status, road traffic noise levels and PM_2.5 as covariates. See all numbers and p-values in supplementary table S2. PA: physical activity; MVPA: moderate-to-vigorous physical activity; PM_2.5: particles with a 50% cut-off aerodynamic diameter of 2.5 µm.