D26-12 Outdoor Air Pollutant Exposure Is Associated With Accelerated Lung Function Decline in a High-risk HIV Cohort

Abstract Rationale Air pollution remains a major contributor to respiratory morbidity worldwide. While in recent years air quality has improved in the United States, reductions in air pollution exposure have not been distributed evenly, with low income and predominantly Black communities still facing a higher burden of disease from PM2.5 and NO2 exposure. We aimed to describe the associations between lung function decline and both long-term outdoor air pollution exposure and change in exposure over time in a low-income urban cohort. Methods We utilized data from the Study of HIV in the Etiology of Lung Disease (SHIELD), conducted in Baltimore, MD from 2009-2019. SHIELD consists of a vulnerable primarily low-income Black population of people with and without HIV. We studied associations between spirometric lung function decline (using FEV1 and FVC) and both mean and rate of change in exposure (PM2.5 and NO2), estimated from EPA data based on geocoded address, during follow-up. Analyses were restricted to participants 30 years old with ≥4 visits. We performed precision-weighted least squares regressions of the rate of change in lung function on the mean and rate of change of exposure during follow-up, adjusting for baseline COPD status and lung function measure, demographics, and baseline height, BMI category, smoking status and pack-years, injection drug use, and HIV-serostatus. We also estimated associations stratified by HIV-serostatus. Results Analyses included 953 participants who contributed 9,810 spirometry visits, with a meanSD follow-up time of 6.92.7 years. The cohort was 67.8% male, 89.5% Black, and at baseline had mean age 50.37.5 years and 30% positive HIV-serostatus. The mean baseline FEV1% predicted was 83.016.2% with mean baseline PM2.5 10.51.0 µg/m3 and NO2 16.72.0 ppb. Higher mean PM2.5 and NO2, and a lower rate of decline in PM2.5 , were associated with a higher rate of decline in both lung function measures (Figure). A one-standard-deviation (0.67 µg/m3) increase in mean PM2.5 exposure was associated with a 10.6(6.2-15.0) ml/year higher rate of decline in FEV1. There were not consistently significant differences in the associations by HIV-serostatus. Conclusions Our results demonstrate that both higher mean exposure to outdoor air pollution and, in some cases, a lower rate of decline in outdoor pollution concentration over time are associated with a higher rate of lung function decline within this well-phenotyped and vulnerable population. These findings underscore the importance of air pollution in lung health, and the need for efforts that promote equitable improvements in air quality. This abstract is funded by: NHLBI