Social-environmental phenotypes of rapid cystic fibrosis lung disease progression in adolescents and young adults living in the United States

•Environmental influences on early cystic fibrosis lung disease are not well characterized.•Clustering yielded social-environmental lung phenotypes that corresponded to rapid decline that occurred in early adolescence, mid adolescence, or later in early adulthood.•Timing of peak decline varied by social-environmental adversity.•Social and environmental health disparities impacted middle decliners the most.•Severity of rapid decline differed by regional community.