Deprivation, far hospital distance raise mortality risk in IPF
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Key takeaways:
- Living more than 24.1 miles away from a respiratory clinic negatively impacted survival in patients with IPF.
- Socially deprived patients had poor outcomes signaling more severe disease.
The risk for mortality was heightened among patients with idiopathic pulmonary fibrosis who experienced more deprivation and lived far from a hospital, according to results published in Respiratory Medicine.
“People from all circumstances, especially socially deprived, need early and appropriate treatment for their pulmonary fibrosis,” Andrew M. Wilson, MD, clinical senior lecturer in respiratory health at Norwich Medical School at the University of East Anglia, told Healio. “Ways of delivering care closer to home are also needed.”
Using 2013 to 2021 data from the British Thoracic Society Interstitial Lung Diseases Registry, Wilson and colleagues conducted a retrospective cohort study evaluating 2,359 patients (mean age, 73.6 years; 79.5% men) with IPF to find the impact of socioeconomic status (Index of Multiple Deprivation 2019 score), hospital distance from home and time from initial symptoms to hospital visit on survival via Cox proportional hazards models.
Of the total cohort, 469 patients belonged to the most deprived quintile (quintile 1), whereas 544 belonged to the least deprived quintile (quintile 5).
The remaining patients fell into quintile two (n = 389), three (n = 447) or four (n = 510).
At baseline, current/former smoking status was found more often in the most vs. least deprived quintile (72.6% vs. 65.6%).
Further, among patients with more vs. less deprivation, researchers observed reduced lung function (mean FVC, 75.8 vs. 80.4), a higher mean Gender Age Physiology (GAP) index score (4.66 vs. 4.27), more need for supplemental oxygen (46.7% vs. 12.1%), more antifibrotic therapy prescriptions (93.4% vs. 78.3%), more pulmonary rehabilitation referrals (69.1% vs. 45.8%) and a greater proportion of patients who waited over 2 years after symptom onset to go to the hospital (42% vs. 36.2%).
“We did not expect to see that people with increased social deprivation had more severe disease when they were seen at specialist centres,” Wilson said.
During a median follow-up period of 28 months, 875 of 1,380 patients (63.4%) passed away.
The risk for mortality was heightened among those with more vs. less deprivation (adjusted HR = 1.39; 95% CI, 1.11-1.73) in a model accounting for age, smoking status, GAP index, hospital distance and time to referral, according to researchers.
Researchers also found that distance between home and a respiratory clinic impacted survival, with an elevated risk for mortality among those furthest (> 24.1-85.1 miles) vs. closest (≤ 4 miles) to a clinic (aHR = 1.29; 95% CI, 1.01-1.64). Wilson noted this finding was unexpected.
In terms of time to referral, the only time a higher mortality risk was significant was with a delay of 6 to 12 months vs. less than 6 months (aHR = 1.34; 95% CI, 1.02-1.77).
Lastly, the risk for death rose as GAP stages progressed. Compared with patients in stages zero to three, patients in stages four to five (aHR = 2.17; 95% CI, 1.78-2.64) and stages six to eight (aHR = 3.42; 95% CI, 2.73-4.28) faced greater mortality risks.
“This study is timely because the integrated clinical care pathway for providing care for people with interstitial lung disease is being developed,” Wilson said. “Future studies need to explore the reasons for the delayed referral in more detail.”