Goobie Gillian C, Ryerson Christopher J, Johannson Kerri A, Schikowski Erin, Zou Richard H, Khalil Nasreen, Marcoux Veronica, Assayag Deborah, Manganas Hélène, Fisher Jolene H, Kolb Martin R J, Gibson Kevin F, Kass Daniel J, Zhang Yingze, Lindell Kathleen O, Nouraie S Mehdi
Department of Human Genetics, Graduate School of Public Health, and.
Simmons Center for Interstitial Lung Disease, Division of Pulmonary, Allergy and Critical Care Medicine.
Am J Respir Crit Care Med. 2022 Feb 15;205(4):459-467. doi: 10.1164/rccm.202109-2065OC.
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. 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. 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. 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, = 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, = 0.04). Greater disadvantage was associated with reduced baseline DL in both cohorts, but it was not associated with baseline FVC or FVC or DL decline in either cohort. 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.
纤维化间质性肺病（fILD）是一组以肺部瘢痕形成、高发病率和高死亡率为特征的病理实体。目前缺乏关于社会经济和居住因素如何影响fILD患者预后的研究。为了确定美国和加拿大fILD患者社区层面的不利因素与疾病表现严重程度、疾病进展、肺移植及死亡率之间的关联。我们对来自美国1个和加拿大8个ILD登记点的4729例fILD患者进行了一项多中心、国际性、前瞻性队列研究。美国通过地区剥夺指数、加拿大通过多重剥夺指数来衡量社区层面的不利因素。在美国队列而非加拿大队列中，生活在最不利社区（最高四分位数）的fILD患者死亡率最高（风险比=1.51，P=0.002），在特发性肺纤维化患者亚组中，处于不利因素最高四分位数的患者接受肺移植的几率最低（优势比=0.46，P=0.04）。在两个队列中，更大的不利因素都与基线DL降低相关，但与基线FVC或FVC及DL下降均无关。在美国，生活在社区层面不利因素更大地区的fILD患者死亡率更高，而特发性肺纤维化患者接受肺移植的几率更低。这些差异在加拿大患者中未观察到，这可能表明美国和加拿大在医疗服务可及性方面存在差异。
