Lucile Sesé1, Julien Caliez2, Isabella Annesi-Maesano3, Vincent Cottin4, Giancarlo Pesce5, Morgane Didier2, Zohra Carton2, Dominique Israel-Biet6, Bruno Crestani7, Stéphanie Guillot Dudoret8, Jacques Cadranel9, Benoit Wallaert10, Abdellatif Tazi11, Bernard Maître12, Grégoire Prévot13, Sylvain Marchand-Adam14, Sandrine Hirschi15, Sandra Dury16, Violaine Giraud17, Anne Gondouin18, Philippe Bonniaud19, Julie Traclet4, Karine Juvin6, Raphael Borie7, Jean François Bernaudin20, Dominique Valeyre21, Catherine Cavalin22, Hilario Nunes23. 1. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France; AP-HP, Service de Physiologie, Hôpital Avicenne, Bobigny, France; Université Sorbonne Paris Nord, INSERM, 1272, « Hypoxie et Poumon: Pneumopathies Fibrosantes, Modulations Ventilatoires et Circulatoires », Bobigny, France; EPAR, IPLESP UMR-S, 1136, INSERM et Sorbonne Université, Paris, France. 2. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France. 3. Institut Desbrest d'Epidémiologie et Santé Publique (IDESP), INSERM et Université de Montpellier, Montpellier, France. 4. Centre de Référence des Maladies Pulmonaires Rares (site Coordonnateur), Hôpital Louis Pradel, Hospices Civils de Lyon, Université Lyon 1, Université de Lyon, INRAE, OrphaLung; Member of Respifil; ERN-LUNG, Lyon, France. 5. EPAR, IPLESP UMR-S, 1136, INSERM et Sorbonne Université, Paris, France. 6. Centre de Compétence des Maladies Pulmonaires Rares, AP-HP, Service de Pneumologie, Hôpital HEGP, Paris, France. 7. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Bichat, Paris, France. 8. Centre de Compétence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Pontchaillou, Rennes, France. 9. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Tenon and Sorbonne University, Paris, France. 10. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), Service de Pneumologie, Hôpital Albert Calmette, Lille, France. 11. Université de Paris, F-75006, Paris, Centre de Référence National des Histiocytose, AP-HP, Service de Pneumologie, Hôpital Saint-Louis, Paris, France. 12. AP-HP, Service de Pneumologie, Hôpital Henri Mondor, Université Paris Est, INSERM U955, 94 000, Créteil, France. 13. Centre de Compétence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Larrey, Toulouse, France. 14. Centre de Compétence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Bretonneau, Tours, France. 15. Centre de Compétence des Maladies Pulmonaires Rares, Service de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France. 16. Centre de Compétence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Maison Blanche, Reims, France. 17. AP-HP, Service de Pneumologie, Hôpital Ambroise Paré, Boulogne, France. 18. Centre de Compétence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Jean Minjoz, Besançon, France. 19. Centre Référence des Maladies Pulmonaires Rares (site Constitutif), Service de Pneumologie, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France. 20. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France; EPAR, IPLESP UMR-S, 1136, INSERM et Sorbonne Université, Paris, France. 21. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France; Université Sorbonne Paris Nord, INSERM, 1272, « Hypoxie et Poumon: Pneumopathies Fibrosantes, Modulations Ventilatoires et Circulatoires », Bobigny, France. 22. Institut de Recherche Interdisciplinaire en Sciences Sociales (IRISSO, UMR CNRS-INRAE 7170-1427), Paris-Dauphine Université, PSL, Paris, France; Laboratoire Interdisciplinaire D'évaluation des Politiques Publiques de Sciences Po (LIEPP), Sciences Po, Paris, France. 23. Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Avicenne, Bobigny, France; Université Sorbonne Paris Nord, INSERM, 1272, « Hypoxie et Poumon: Pneumopathies Fibrosantes, Modulations Ventilatoires et Circulatoires », Bobigny, France. Electronic address: hilario.nunes@aphp.fr.
Abstract
BACKGROUND: Low income, a known prognostic indicator of various chronic respiratory diseases, has not been properly studied in idiopathic pulmonary fibrosis (IPF). We hypothesize that a low income has an adverse prognostic impact on IPF. METHODS: Patients were selected from the French national prospective cohort COFI. Patients' income was assessed through the median city-level income provided by the French National Institute of Statistics and Economic Studies according to their residential address. Patients were classified in two groups as "low income" vs. "higher income" depending on whether their annual income was estimated to be < or ≥18 170 €/year (the first quartile of the income distribution in the study population). The survival and progression-free survival (PFS) of the groups were compared by a log-rank test and a Cox model in multivariate analysis. RESULTS: 200 patients were included. The average follow-up was 33.8 ± 22.7 months. Patients in the low income group were significantly more likely to be of non-European origin (p < 0.006), and to have at least one occupational exposure (p < 0.0001), and they tended to have a higher cumulative exposure to fine particles PM2.5 (p = 0.057). After adjusting for age, gender, forced vital capacity at inclusion, geographical origin, and occupational exposure having a low-income level was a factor associated with a worse PFS (HR: 1.81; CI95%: 1.24-2.62, p = 0.001) and overall survival (HR: 1.49; CI95%: 1.0006-2.23, p = 0.049). CONCLUSIONS: Low income appears to be a prognostic factor in IPF. IPF patients with low incomes may also be exposed more frequently to occupational exposures.
BACKGROUND: Low income, a known prognostic indicator of various chronic respiratory diseases, has not been properly studied in idiopathic pulmonary fibrosis (IPF). We hypothesize that a low income has an adverse prognostic impact on IPF. METHODS: Patients were selected from the French national prospective cohort COFI. Patients' income was assessed through the median city-level income provided by the French National Institute of Statistics and Economic Studies according to their residential address. Patients were classified in two groups as "low income" vs. "higher income" depending on whether their annual income was estimated to be < or ≥18 170 €/year (the first quartile of the income distribution in the study population). The survival and progression-free survival (PFS) of the groups were compared by a log-rank test and a Cox model in multivariate analysis. RESULTS: 200 patients were included. The average follow-up was 33.8 ± 22.7 months. Patients in the low income group were significantly more likely to be of non-European origin (p < 0.006), and to have at least one occupational exposure (p < 0.0001), and they tended to have a higher cumulative exposure to fine particles PM2.5 (p = 0.057). After adjusting for age, gender, forced vital capacity at inclusion, geographical origin, and occupational exposure having a low-income level was a factor associated with a worse PFS (HR: 1.81; CI95%: 1.24-2.62, p = 0.001) and overall survival (HR: 1.49; CI95%: 1.0006-2.23, p = 0.049). CONCLUSIONS: Low income appears to be a prognostic factor in IPF. IPF patients with low incomes may also be exposed more frequently to occupational exposures.
Authors: Aparna C Swaminathan; Anne S Hellkamp; Megan L Neely; Shaun Bender; Luca Paoletti; Eric S White; Scott M Palmer; Timothy P M Whelan; Daniel F Dilling Journal: Ann Am Thorac Soc Date: 2022-06