Black patients with pulmonary fibrosis younger at diagnosis, hospitalization, death
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Key takeaways:
- Compared with Hispanic and white patients with pulmonary fibrosis, Black patients were diagnosed and died at an earlier age.
- Hospitalization and lung transplants also occurred earlier in Black patients with pulmonary fibrosis.
Black patients with pulmonary fibrosis are younger at diagnosis and death than Hispanic and white patients with pulmonary fibrosis, according to study results published in JAMA Network Open.
“The fundamental principle behind successful screening drives is that earlier diagnosis improves longevity; however, in the Black pulmonary fibrosis [PF] population, the age disparities appeared entrenched, and Black patients never caught up to others even up till the time of death, suggesting the need to be even more aggressive with screening and intervening in populations at the highest risk,” Deji Adegunsoye, MD, MS, FCCP, assistant professor of medicine at The University of Chicago, told Healio.
In a cohort study, Adegunsoye and colleagues analyzed 4,792 adults (mean age, 66.1 years; 58% men) with PF between January 2003 and April 2021 to evaluate racial and ethnic differences in ages at PF diagnosis, hospitalization, lung transplantation and mortality.
Of the total cohort, 10.2% were Black, 6.7% were Hispanic and 83.2% were white.
Researchers assessed 1,904 patients from the Pulmonary Fibrosis Foundation Registry (PFFR), which made up the primary cohort, and 2,888 patients from four geographically distinct U.S. hospitals, which made up the external multicenter validation (EMV) cohort.
To compare various factors between the three racial and ethnic groups, researchers used several tests, as well as Cox proportional hazards regression models to compare crude mortality rates and rate ratios.
Age at diagnosis, characteristics
Compared with white patients’ mean age at PF diagnosis, researchers found that Black patients received a diagnosis at an age that was almost 10 years younger (mean age, 68.6 years vs. 57.9 years; P < .001) in the primary cohort. A younger age at diagnosis was also observed in Black patients when compared with Hispanic patients (mean age, 65.4 years). The EMV cohort demonstrated similar results, according to researchers.
In terms of sex, researchers found a smaller percentage of Black men with PF (PFFR, 32 out of 105; 30.5%; EMV, 102 out of 383; 26.6%) compared with Hispanic men (PFFR, 73 out of 124; 58.9%; EMV, 109 out of 195; 55.9%) and white men (PFFR, 1,090 out of 1675; 65.1%; EMV, 1,373 out of 2,310; 59.4%).
Additionally, in both cohorts, more Black patients had connective tissue disease-associated interstitial lung disease (PFFR, 57 out of 105; 54.3%; EMV, 148 out of 383; 38.6%) than Hispanic (PFFR, 27 out of 124; 21.8%; EMV, 53 out of 195; 27.2%) and white patients (PFFR, 227 out of 1,675; 13.6%; EMV, 290 out of 2,310; 12.6%).
Hispanic patients had a comparable crude mortality rate ratio to white patients (0.89; 95% CI, 0.57-1.35), but Black patients showed a decreased mortality rate ratio than that of white patients (0.57; 95% CI, 0.31-0.97) in the primary cohort; this was similar in the EMV cohort.
Rate, age at lung transplant, hospitalization
Researchers found that in both the primary and EMV cohort, fewer Black patients (PFFR, 9 out of 105 patients; 8.6%; EMV, 21 out of 374; 5.6%) received a lung transplant when compared with Hispanic (PFFR, 14 out of 124; 11.3%; EMV, 18 out of 164; 11%) or white patients (PFFR, 162 out of 1,675; 9.7%; EMV, 219 out of 2,117; 10.3%).
Hospitalization outcomes also differed by racial and ethnic groups, with Black patients showing the greatest mean amount of hospitalization events (3.6) per person in the primary cohort than Hispanic (1.8 events per person) and white patients (1.7 events per person; P < .001). This finding was also observed in the EMV cohort, with Black patients experiencing 2.6 events per person whereas Hispanic patients experienced 1.9 events per person and white patients experienced 1.8 events per person (P < .001).
Similar to the age finding at PF diagnosis, researchers found Black patients were younger than Hispanic and white patients when receiving a lung transplant (mean age, 58.6 years vs. 60.5 years vs. 66.9 years) and at first hospitalization (mean age, 59.4 years vs. 67.5 years vs. 70 years) in the primary cohort.
The EMV cohort demonstrated comparable results with younger Black patients than Hispanic and white patients receiving a lung transplant (mean age, 52 years vs. 61.8 years vs. 62.8 years) and at first hospitalization (mean age, 59.7 years vs. 64.9 years vs. 64.6 years).
Additionally, Hispanic patients lived to 72.9 years and white patients lived to 73.5 years, whereas Black patients did not survive as long with a mean age at death of 68.7 years in the PFFR cohort. Researchers reported similar findings in the EMV cohort with a younger mean age of death reported in Black patients (65 years) than in Hispanic (68.2 years) and white patients (71.9 years).
“We found that the highest risk clinical phenotype for these age-related outcome disparities appeared to be Black females with autoimmune disease, in contrast to the typical high-risk category of older white males that many clinicians think about for PF,” Adegunsoye told Healio. “Also, it is quite telling that the majority of Black individuals with a defined pulmonary fibrosis subtype had autoimmune disease at diagnosis, suggesting that the systemic ailment drew attention to the lungs. This highlights the need to carefully and promptly evaluate symptoms like cough or difficulty with breathing and intervene earlier where necessary because by the time non-pulmonary signs set in, it may be too late.”
When asked about the applicability of the study findings, Adegunsoye emphasized that the results occurred in two separate cohorts.
“The consistency of the findings between the primary and replication cohorts was quite compelling and to me underscores the veracity of our findings in the general population,” he said.
In terms of future studies, Adegunsoye hopes for more focus on minority populations, as well as a start to understanding why Black patients are younger when they are diagnosed, hospitalized and die.
“I hope future studies will be even larger and more inclusive as minority populations are still underrepresented in many of these registries for numerous reasons, including access to care, suboptimal insurance and many other structural and socioeconomic reasons,” Adegunsoye told Healio. “Perhaps more importantly, I hope future studies are more mechanistic and really help us begin to understand the reason behind these detrimental outcomes so we can address them in our search for a cure for all patients.”
For more information:
Deji Adegunsoye, MD, MS, FCCP, can be reached at deji@uchicago.edu.
Reference:
- Black patients are diagnosed with, hospitalized for and die of pulmonary fibrosis at younger ages than white patients. https://www.eurekalert.org/news-releases/982398. Published March 10, 2023. Accessed March 13, 2023.