ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
Search Tips:
- Use the keyword search to search by keyword or author's name.
- Filter your search results by selecting the checkboxes that apply.
- Click on "Clear" to clear the form and start a new search. .
Search results will display below the form.
Neighborhood-Level Disadvantage Impacts Mortality and Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis
Session Title
A7 - A007 IMPACT OF RACE, ETHNICITY, AND SOCIAL DETERMINANTS ON INDIVIDUALS WITH LUNG DISEASES
Abstract
A1033 - Neighborhood-Level Disadvantage Impacts Mortality and Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis
Author Block: G. C. Goobie1, D. Kass2, Y. Zhang2, K. F. Gibson2, R. H. Zou2, S. Nouraie2, K. O. Lindell3; 1Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States, 2Division of Pulmonary, Allergy, and Critical Care Medicine University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, United States, 3College of Nursing, Medical University of South Carolina, Charlston, SC, United States.
Background: Social determinants of health impact the outcome of many chronic diseases. Environmental and occupational factors contribute to the development and progression of idiopathic pulmonary fibrosis (IPF); however, the impacts of neighborhood-level socioeconomic factors have not been clearly defined. Neighborhood-level disadvantage, as measured by the Area Deprivation Index (ADI), is a surrogate measure of socioeconomic status that is implicated with health outcomes.
Methods: Consecutive patients with IPF were enrolled into the prospective University of Pittsburgh Simmons Center for Interstitial Lung Disease (ILD) Registry at UPMC beginning in March 2000, with data collection through to January 2020. Geocoded residential address was used to determine individual ADI. We used multivariable Cox hazards models to test the association of ADI and mortality (considering time to death or lung transplant as a composite outcome). Binary and multinomial logistic regression were used to evaluate the impact of ADI on odds of receiving a lung transplant and location of death, respectively. Models were adjusted for age, sex, smoking status, race, and baseline lung function (forced vital capacity, FVC; and diffusion capacity for carbon monoxide, DLCO).
Results: 410 patients with IPF were evaluated for the primary outcome. The highest ADI quartile (indicating the greatest level of neighborhood-level disadvantage) was associated with a hazard ratio (HR) of 2.10 (95% CI 1.25-3.52; p-value = 0.005) compared to the first quartile (Figure 1). There was no association between continuous ADI or ADI quartile and baseline FVC or DLCO. Highest ADI quartile was associated with lower odds of receiving a lung transplant (odds ratio, OR = 0.57; 95% CI 0.32-0.98; p-value = 0.045). Of 110 patients for whom location of death information was available (17%, 32%, 35%, and 15% died at home, in hospice, on a hospital floor, and in the ICU respectively), there was no association between ADI and this outcome.
Conclusions: Patients with IPF living in neighborhoods with the highest disadvantage level experience increased risk of mortality and are less likely to receive a lung transplant. These
findings suggest that the ADI is a practical indicator of socioeconomic status that can be used in the future to explore health disparities in the IPF patient population.
Figure 1: Forest plot demonstrating the multivariable Cox proportional hazards model looking at the impact of Area Deprivation Index (ADI) quartile and other covariates on risk of death or lung transplant (considered as a composite endpoint).
Author Block: G. C. Goobie1, D. Kass2, Y. Zhang2, K. F. Gibson2, R. H. Zou2, S. Nouraie2, K. O. Lindell3; 1Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States, 2Division of Pulmonary, Allergy, and Critical Care Medicine University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, United States, 3College of Nursing, Medical University of South Carolina, Charlston, SC, United States.
Background: Social determinants of health impact the outcome of many chronic diseases. Environmental and occupational factors contribute to the development and progression of idiopathic pulmonary fibrosis (IPF); however, the impacts of neighborhood-level socioeconomic factors have not been clearly defined. Neighborhood-level disadvantage, as measured by the Area Deprivation Index (ADI), is a surrogate measure of socioeconomic status that is implicated with health outcomes.
Methods: Consecutive patients with IPF were enrolled into the prospective University of Pittsburgh Simmons Center for Interstitial Lung Disease (ILD) Registry at UPMC beginning in March 2000, with data collection through to January 2020. Geocoded residential address was used to determine individual ADI. We used multivariable Cox hazards models to test the association of ADI and mortality (considering time to death or lung transplant as a composite outcome). Binary and multinomial logistic regression were used to evaluate the impact of ADI on odds of receiving a lung transplant and location of death, respectively. Models were adjusted for age, sex, smoking status, race, and baseline lung function (forced vital capacity, FVC; and diffusion capacity for carbon monoxide, DLCO).
Results: 410 patients with IPF were evaluated for the primary outcome. The highest ADI quartile (indicating the greatest level of neighborhood-level disadvantage) was associated with a hazard ratio (HR) of 2.10 (95% CI 1.25-3.52; p-value = 0.005) compared to the first quartile (Figure 1). There was no association between continuous ADI or ADI quartile and baseline FVC or DLCO. Highest ADI quartile was associated with lower odds of receiving a lung transplant (odds ratio, OR = 0.57; 95% CI 0.32-0.98; p-value = 0.045). Of 110 patients for whom location of death information was available (17%, 32%, 35%, and 15% died at home, in hospice, on a hospital floor, and in the ICU respectively), there was no association between ADI and this outcome.
Conclusions: Patients with IPF living in neighborhoods with the highest disadvantage level experience increased risk of mortality and are less likely to receive a lung transplant. These
findings suggest that the ADI is a practical indicator of socioeconomic status that can be used in the future to explore health disparities in the IPF patient population.
Figure 1: Forest plot demonstrating the multivariable Cox proportional hazards model looking at the impact of Area Deprivation Index (ADI) quartile and other covariates on risk of death or lung transplant (considered as a composite endpoint).
