New Research Shows Negative Consequences for Patients With Fibrotic Interstitial Lung Disease Who Live in Disadvantaged Areas

A multidisciplinary team of researchers from the University of Pittsburgh and eight Universities and Hospitals in Canada has published data from the first study to examine outcomes in patients with fibrotic interstitial lung disease (fILD) who reside in disadvantaged neighborhoods. Gillian C. Goobie, MD, FRCPC, from the University of Pittsburgh Graduate School of Public Health Department of Human Genetics, was the lead author. S. Mehdi Nouraie, MD, PhD, from the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pittsburgh School of Medicine and Kathleen O. Lindell, RN, PhD, adjunct faculty with the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh, were the senior authors of the research.

Study Overview and Key Clinical Highlights

While race, ethnicity, socioeconomic, and geographic factors have been shown in other research studies to influence a wide range of health care outcomes – morbidity and mortality, access to care, and other measures – little research has been conducted on how socioeconomic and neighborhood-related factors may influence outcomes for patients with fILD.

To discover if any gaps in care or disparities in outcomes exist for this patient population, the study team reviewed cases of fILD from the University of Pittsburgh Simmons Center for ILD Patient Registry and the Canadian Registry for Pulmonary Fibrosis (CARE-PF) between the years 2000 and 2021. Neighborhood-level disadvantage was determined for U.S. patients using the area deprivation index (ADI) and was determined for Canadian patients with the correlative Canadian Index of Multiple Deprivation (CIMD), which are tools that determine disadvantage based on a number of material and social factors derived from census data. The cohort of patients totaled 4,729, with 1,372 from the Pittsburgh registry and 3,357 from the Canadian registry.

The cohorts were analyzed statistically across a number of key measures, including mortality risk, the likelihood of receiving a lung transplant, and pulmonary function.

The study found that U.S. patients living in neighborhoods with the highest levels of disadvantage experienced higher mortality. It also found that as the level of disadvantage increased, patients with idiopathic pulmonary fibrosis (IPF), the most common and severe form of fILD, were less likely to receive treatment with lung transplantation.

However, the findings only applied to the United States cohort of patients. Canadian patients with similar diseases and socioeconomic and neighborhood characteristics did not suffer the same disparities in mortality or access to lung transplantation.

U.S. patients with fILD who live in disadvantaged areas experience suboptimal outcomes relative to these measures compared to their Canadian neighbors. One significant difference between the two countries is Canada's universal health care system, which may contribute to the lower mortality and differences in transplantation access; however, further analysis will be required to better understand these dynamics in detail.

Additionally, the investigators noted that a patient's race appears to influence lung transplant outcomes regardless of country of origin, with non-white patients being less likely to receive transplant. These findings also require further study to identify and mitigate the causes of racial and socioeconomic disparities in patients with fILD.

For more information or to make a patient referral, please email Dr. Goobie at goobiegc@upmc.edu. 

Reference

Goobie GC, Ryerson CJ, Johannson KA, Schikowski E, Zou RH, Khalil N, Marcoux V, Assayag D, Manganas H, Fisher JH, Kolb MRJ, Gibson KF, Kass DJ, Zhang Y, Lindell KO, Nouraie SM. Neighborhood-level Disadvantage Impacts on Patients With Fibrotic Interstitial Lung Disease. Am J Respir Crit Care Med. 2021 Nov 24. Epub ahead of print.