Industrialized communities along the U.S. Gulf Coast face persistent respiratory health inequities that are shaped by cumulative environmental exposures and social vulnerability. This study examined how residential proximity to multiple pollution sources interacts with sociodemographic and behavioral factors to influence respiratory outcomes in two industrial cities in Southeast Texas. A cross-sectional mixed methods design integrated survey data from 2,965 adult residents with 13 qualitative interviews. Multivariable logistic regression models estimated associations between self-reported residential proximity to pollution sources and physician-diagnosed asthma, chronic obstructive pulmonary disease (COPD), and other lung diseases, and included interaction terms to assess effect modification by age, sex, race/ethnicity, and smoking status. Respiratory conditions were common: 38.3% reported asthma, 11.1% COPD, and 6.0% other lung diseases. Proximity to pesticide-related industries was associated with substantially higher odds of asthma (OR = 3.11, 95% CI: 2.11–4.59) and other lung diseases (OR = 3.14, 95% CI: 1.71–5.75). Living near waste management facilities associated with substantial higher odds of asthma (OR = 2.62, 95% CI: 1.83–3.75) and COPD (OR = 3.05, 95% CI: 1.95–4.76). Self-reported proximity to industrial factories was strongly associated with asthma (OR = 3.11, 95% CI: 2.35–4.11) and COPD (OR = 1.80, 95% CI: 1.14–2.82). Interaction models revealed subgroup-specific patterns of association. Smoking modified the association between self-reported traffic exposure and asthma with higher odds observed among active smokers reporting high traffic exposure (Active smoker × high traffic: OR = 1.88; p < 0.05). Among adults aged 50–59, residential proximity to refineries was associated with substantially higher odds of COPD (OR = 10.57; p < 0.001). Gender also modified the association between pesticide-related exposure to lung disease, with women exhibiting lower relative odds compared with men (interaction OR = 0.34; p < 0.05). Longer residential duration was associated with higher odds of lung disease, while residential stability showed outcome-specific and divergent associations across respiratory conditions. Qualitative interviews highlighted chronic exposure to industrial emissions, inadequate risk communication, limited mobility, and barriers to healthcare, reinforcing and contextualizing the quantitative associations. Respiratory health risks in Gulf Coast fence-line communities are shaped by intersecting environmental exposures, behavioral factors, and social conditions. Elevated risks associated with proximity to pesticide-related industries, waste facilities, and industrial factories, combined with differential vulnerabilities across age, gender, and smoking status, underscore the cumulative nature of environmental health burdens. Addressing these inequities requires community-engaged, place-based interventions and policies that simultaneously target industrial emissions, risk communication, and broader structural determinants of health.
Iyanda et al. (Fri,) studied this question.