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We used a stochastic model to predict lung function, measured as forced expiratory volume in 1\u2009s (FEV<jats:sub>1<\/jats:sub>) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>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, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001; the difference in Akaike Information Criterion: 15). An increase of 0.1\u2009\u03bcg\/m<jats:sup>3<\/jats:sup> of ECAT was associated with 0.104% predicted\/yr (95% confidence interval: 0.024,\u00a00.183) more rapid decline. Although not statistically significant, material deprivation was similarly associated (0.1\u2010unit increase corresponded to additional decline of 0.103% predicted\/year [\u22120.113, 0.319]). High\u2010risk regional areas of rapid decline and age\u2010related heterogeneity were identified from prediction mapping.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Traffic\u2010related air pollution exposure is an important predictor of rapid pulmonary decline that, coupled with community\u2010level material deprivation and routinely collected demographic\/clinical characteristics, enhance CF prognostication and enable personalized environmental health interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.26352","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T05:10:11Z","timestamp":1676265011000},"page":"1501-1513","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Built environment factors predictive of early rapid lung function decline in cystic fibrosis"],"prefix":"10.1002","volume":"58","author":[{"given":"Emrah","family":"Gecili","sequence":"first","affiliation":[{"name":"Division of Biostatistics &amp; Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole","family":"Brokamp","sequence":"additional","affiliation":[{"name":"Division of Biostatistics &amp; Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Department of Pediatrics University of Cincinnati Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Rasnick","sequence":"additional","affiliation":[{"name":"Division of Biostatistics &amp; Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro M.","family":"Afonso","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Erasmus Medical Center Rotterdam The Netherlands"},{"name":"Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni\u2010Rosalina","family":"Andrinopoulou","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Erasmus Medical Center Rotterdam The Netherlands"},{"name":"Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith W.","family":"Dexheimer","sequence":"additional","affiliation":[{"name":"Division of Biomedical Informatics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"Clancy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati Cincinnati Ohio USA"},{"name":"Division of Pulmonary Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Cystic Fibrosis Foundation  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth H.","family":"Keogh","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yizhao","family":"Ni","sequence":"additional","affiliation":[{"name":"Division of Biomedical Informatics Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5237-1397","authenticated-orcid":false,"given":"Anushka","family":"Palipana","sequence":"additional","affiliation":[{"name":"Division of Biostatistics &amp; 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