Ben Johnson1, Rodrigue Ngueyep2, Michael S Schechter3, Nicoleta Serban4, Julie Swann5. 1. Revenue Analytics, Atlanta, Georgia. 2. IBM Thomas J Watson, Yorktown Heights, New York. 3. Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia. 4. Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Georgia. 5. Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina.
Abstract
INTRODUCTION: This paper considers the impact of geographic distance from cystic fibrosis centers on lung function in children, young adults, and adults with cystic fibrosis. METHODS: Clinical patient-level data on 20 351 patients from 1986 to 2011 were evaluated from the Cystic Fibrosis Foundation National Patient Registry. We measure distance using a patient's zip code centroid to the center where they received care. A heteroscedastic mixed effects model was used to capture the association of distance with longitudinal variation in patients' lung function. RESULTS: Children, young adults, and adults in lower socioeconomic categories had a %FEV1 between 3 and 10 percentage-points lower than those living in higher income areas and those privately insured. For patients who changed distance categories, high distance was associated with lower lung function in young adults (P-value <0.001). For older patients we observed the reverse, suggesting that the choice to move farther away is associated with better health (P-value <0.001). For patients who did not change distance categories, only medium distance in children was significant (P-value = 0.01). Known confounding factors including age and CFTR mutation class were statistically significantly associated to health outcomes (P-value <0.001). CONCLUSIONS: This study shows distance is not found to be associated with health lung function among patients whose distance category remained unchanged during the analysis. For patients who move, the association of health with distance depends on the age of the patient; adult patients further from their care center are healthier. Overall, we find that socioeconomic and genetic factors appear to impact health outcomes to a greater extent.
INTRODUCTION: This paper considers the impact of geographic distance from cystic fibrosis centers on lung function in children, young adults, and adults with cystic fibrosis. METHODS: Clinical patient-level data on 20 351 patients from 1986 to 2011 were evaluated from the Cystic Fibrosis Foundation National Patient Registry. We measure distance using a patient's zip code centroid to the center where they received care. A heteroscedastic mixed effects model was used to capture the association of distance with longitudinal variation in patients' lung function. RESULTS:Children, young adults, and adults in lower socioeconomic categories had a %FEV1 between 3 and 10 percentage-points lower than those living in higher income areas and those privately insured. For patients who changed distance categories, high distance was associated with lower lung function in young adults (P-value <0.001). For older patients we observed the reverse, suggesting that the choice to move farther away is associated with better health (P-value <0.001). For patients who did not change distance categories, only medium distance in children was significant (P-value = 0.01). Known confounding factors including age and CFTR mutation class were statistically significantly associated to health outcomes (P-value <0.001). CONCLUSIONS: This study shows distance is not found to be associated with health lung function among patients whose distance category remained unchanged during the analysis. For patients who move, the association of health with distance depends on the age of the patient; adult patients further from their care center are healthier. Overall, we find that socioeconomic and genetic factors appear to impact health outcomes to a greater extent.
Authors: Dana Albon; Aricca D Van Citters; Thida Ong; Olivia Dieni; Christopher Dowd; Anne Willis; Kathryn A Sabadosa; Peter Scalia; Kimberly Reno; Gabriela R Oates; Michael S Schechter Journal: J Cyst Fibros Date: 2021-12 Impact factor: 5.482
Authors: Rhonda Szczesniak; Jessica L Rice; Cole Brokamp; Patrick Ryan; Teresa Pestian; Yizhao Ni; Eleni-Rosalina Andrinopoulou; Ruth H Keogh; Emrah Gecili; Rui Huang; John P Clancy; Joseph M Collaco Journal: Expert Rev Respir Med Date: 2020-04-26 Impact factor: 3.772