Disparities Seen in Outcomes for Black Patients With Pulmonary Fibrosis

In a study on racial and ethnic disparities in patients with pulmonary fibrosis (PF), Black patients were found to be younger at the time of diagnosis, hospitalization, and death than White patients.

The results of this cohort study were published in JAMA Network Open.¹

Pulmonary fibrosis is a disease that kills up to half of patients within 5 years of diagnosis. Despite such devastating outcomes, little is known about what racial and ethnic disparities exist.

The study sought to test the hypothesis that the age at clinically relevant outcomes (diagnosis, hospitalization, lung transplant, and death) in PF differs by racial or ethnic category.

Researchers included a total of 4792 participants with a diagnosis of PF from prospective clinical registries, the Pulmonary Fibrosis Foundation Registry (PFFR), and from 4 external multicenter validation (EMV) cohorts in the United States from January 2003 to April 2021.

From the cohorts, 2779 (58%) were male, 488 (10.2%) Black, 319 (6.7%) Hispanic, and 3985 (83.2%) White. Additionally, 1904 patients were in the PFFR cohort and 2888 were in the EMV cohort.

The researchers found that Black patients were diagnosed with PF at an average age of 57.9 years, while White patients were diagnosed at an average age of 68.6 years.

Black patients were also less likely to be male (PFFR, 30.5%; EMV, 26.6%) than Hispanic (PFFR, 58.9%; EMV, 55.9%) and White (PFFR, 30.5%; EMV, 59.4%) patients, and more likely to be hospitalized, with a mean standard deviation (SD) hospitalization per person (PFFR: Black, 3.6 [5.0]; Hispanic, 1.8 [1.4]; White, 1.7 [1.3]; P <.001; EMV: Black, 2.6 [2.2]; Hispanic, 1.9 [1.7]; White, 1.8 [1.4]; P <.001).

Black patients were also younger than Hispanic or White patients at the time of initial hospitalization (mean SD age: Black, 59.4 [11.7] years; Hispanic, 67.5 [9.8] years; White, 70 [9.3] years; P<.001), lung transplant (Black, 58.6 [8.6] years; Hispanic, 60.5 [6.1] years; White, 66.9 [6.7] years; P<.001), and death (Black, 68.7 [8.4] years; Hispanic, 72.9 [7.6] years; White, 73.5 [8.7] years; P <.001).

Furthermore, PF was linked to risk factors, such as rheumatoid arthritis, exposure to air pollution, and occupations that make an individual at high risk of inhaling particulate matter and smoking.

The researchers believe that the disparities are likely attributed to lifestyle and socioeconomic factors that disproportionately place Black patients at higher risk of environmental exposures. These results remained consistent in the replication cohort and sensitivity analysis within age groups.

“This disease has no clear cause and no cure, but it is not a cancer; the poor prognosis made me wonder if Black patients are as affected by this disease as whites [patients], and whether or not they experienced different outcomes,” said Ayodeji Adegunsoye, MD, MS, assistant professor at the University of Chicago Medicine, and study’s lead author, in a statement.¹ “And we saw that Black patients’ experience with the disease is accelerated by about 10 years.”

The researchers also believe that racial disparities may be associated with earlier onset of PF outcomes, especially among Black patients. Furthermore, these results highlight a need for policy changes to bring attention to environmental and societal risks that are disproportionately affecting Black patients.

“These results are so profound that I believe we should be screening everyone for pulmonary fibrosis earlier, especially if a patient has any risk factors,” said Adegunsoye. “If you can pick up the disease sooner, the outcomes will improve. We know more about the disease now than we did even 10 years ago, and while there is no cure, there are treatments available — some of them are as simple as changing your environment or wearing a mask to reduce environmental exposure, but there are also drugs that can slow the progression of the disease.”

References

1. UChicagoMed. Black patients are diagnosed with, hospitalized for and die of pulmonary fibrosis at younger ages than white patients. University of Chicago. https://www.eurekalert.org/news-releases/982398. Published March 10, 2023. Accessed March 27, 2023.

2. Adegunsoye A, Freiheit E, White EN, et al. Evaluation of pulmonary fibrosis outcomes by race and ethnicity in US adults. JAMA Netw Open. 2023;6(3). doi:10.1001/jamanetworkopen.2023.2427