Gillian C Goobie1,2,3, Christopher J Ryerson4,5, Kerri A Johannson6, Erin Schikowski7, Richard H Zou8, Nasreen Khalil4, Veronica Marcoux9, Deborah Assayag10, Hélène Manganas11, Jolene H Fisher12, Martin R J Kolb13, Kevin F Gibson2,8, Daniel J Kass2,8, Yingze Zhang8, Kathleen O Lindell2,14, S Mehdi Nouraie8. 1. Department of Human Genetics, Graduate School of Public Health, and. 2. Simmons Center for Interstitial Lung Disease, Division of Pulmonary, Allergy and Critical Care Medicine. 3. Clinician Investigator Program and. 4. Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 5. Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada. 6. Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 7. Division of General Internal Medicine, and. 8. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Division of Respirology, Critical Care and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 10. Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada. 11. Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 12. Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 13. Department of Medicine, Firestone Institute for Respiratory Health, The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; and. 14. College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
Abstract
Rationale: Fibrotic interstitial lung disease (fILD) is a group of pathologic entities characterized by scarring of the lungs and high morbidity and mortality. Research investigating how socioeconomic and residential factors impact outcomes in patients with fILD is lacking. Objectives: To determine the association between neighborhood-level disadvantage and presentation severity, disease progression, lung transplantation, and mortality in patients with fILD from the United States and Canada. Methods: We performed a multicenter, international, prospective cohort study of 4,729 patients with fILD from one U.S. and eight Canadian ILD registry sites. Neighborhood-level disadvantage was measured by the area deprivation index in the United States and the Canadian Index of Multiple Deprivation in Canada. Measurements and Main Results: In the U.S. but not in the Canadian cohort, patients with fILD living in neighborhoods with the greatest disadvantage (top quartile) experience the highest risk of mortality (hazard ratio = 1.51, P = 0.002), and in subgroups of patients with idiopathic pulmonary fibrosis, the top quartile of disadvantage experienced the lowest odds of lung transplantation (odds ratio = 0.46, P = 0.04). Greater disadvantage was associated with reduced baseline DLCO in both cohorts, but it was not associated with baseline FVC or FVC or DLCO decline in either cohort. Conclusions: Patients with fILD who live in areas with greater neighborhood-level disadvantage in the United States experience higher mortality, and patients with idiopathic pulmonary fibrosis experience lower odds of lung transplantation. These disparities are not seen in Canadian patients, which may indicate differences in access to care between the United States and Canada.
Rationale: Fibrotic interstitial lung disease (fILD) is a group of pathologic entities characterized by scarring of the lungs and high morbidity and mortality. Research investigating how socioeconomic and residential factors impact outcomes in patients with fILD is lacking. Objectives: To determine the association between neighborhood-level disadvantage and presentation severity, disease progression, lung transplantation, and mortality in patients with fILD from the United States and Canada. Methods: We performed a multicenter, international, prospective cohort study of 4,729 patients with fILD from one U.S. and eight Canadian ILD registry sites. Neighborhood-level disadvantage was measured by the area deprivation index in the United States and the Canadian Index of Multiple Deprivation in Canada. Measurements and Main Results: In the U.S. but not in the Canadian cohort, patients with fILD living in neighborhoods with the greatest disadvantage (top quartile) experience the highest risk of mortality (hazard ratio = 1.51, P = 0.002), and in subgroups of patients with idiopathic pulmonary fibrosis, the top quartile of disadvantage experienced the lowest odds of lung transplantation (odds ratio = 0.46, P = 0.04). Greater disadvantage was associated with reduced baseline DLCO in both cohorts, but it was not associated with baseline FVC or FVC or DLCO decline in either cohort. Conclusions: Patients with fILD who live in areas with greater neighborhood-level disadvantage in the United States experience higher mortality, and patients with idiopathic pulmonary fibrosis experience lower odds of lung transplantation. These disparities are not seen in Canadian patients, which may indicate differences in access to care between the United States and Canada.
Entities:
Keywords:
health equity; healthcare disparities; interstitial lung disease; residence characteristics; social determinants of health