Racial ethnicity might impact pulmonary fibrosis-related outcomes: JAMA

Racial and ethnic differences, particularly among Black patients, were discovered in pulmonary fibrosis (PF)-related outcomes, including an earlier beginning of mortality, in a research by Ayodeji Adegunsoye and colleagues that included individuals with pulmonary fibrosis. The findings of this study were published in the Journal of American Medical Association.

The lung tissue scars over time in pulmonary fibrosis, and it has a bad prognosis. The highest risk of morbidity and death from inequities affecting respiratory health is seen in racial and ethnic minority groups, however it is uncertain how different racial and ethnic populations with PF age at clinically meaningful outcomes. In order to examine the age at PF-related outcomes and the variation in survival patterns among individuals who were Hispanic, non-Hispanic Black, and non-Hispanic White, this study was carried out.

The Pulmonary Fibrosis Foundation Registry (PFFR) was used for the primary cohort in this cohort analysis, and registries from four geographically separate tertiary institutions in the US were used for the external multicenter validation (EMV) cohort. This cohort study included adult patients with a PF diagnosis and employed data from prospective clinical registries. Patient monitoring lasted from January 2003 to April 2021. The major exposure was comparing the racial and ethnic backgrounds of Black, Hispanic, and White subjects with PF. At the time of study enrolment, participants' ages and gender distributions were assessed. Throughout 14 389 person-years, participants' all-cause mortality as well as the age of PF diagnosis, hospitalization, lung transplantation, and death, were evaluated.

The key findings of this study were:

1. There were 4792 PF individuals examined in total; 1904 were in the PFFR cohort and 2888 were in the EMV cohort.

2. The average age of Black patients with PF was lower than that of White patients.

3. Patients who were Black were less likely to be male than Hispanic or White patients.

4. Black patients had a lower crude death rate ratio than White patients, however for Hispanic patients, the mortality rate ratio was comparable to that of White patients. As compared to Hispanic and White patients, Black patients had the greatest mean (SD) number of hospitalization occurrences per person.

5. At the time of the initial hospitalization or lung transplant, Black patients were almost always younger than Hispanic and White patients.

6. Within certain deciles of age groups, these findings held true both in the replication cohort and in sensitivity analysis.

In racial and ethnic minority groups, and particularly Black patients, racial differences in PF may be linked to early start of fatal outcomes. Age differences were prevalent and permeated every stage of PF's natural history, from diagnosis to disease development, culminating in early hospitalization, lung transplantation, and mortality among communities of color and people of ethnic minorities. For the purpose of locating and reducing the underlying components at fault, more investigation is needed.

Reference:

Adegunsoye, A., Freiheit, E., White, E. N., Kaul, B., Newton, C. A., Oldham, J. M., Lee, C. T., Chung, J., Garcia, N., Ghodrati, S., Vij, R., Jablonski, R., Flaherty, K. R., Wolters, P. J., Garcia, C. K., & Strek, M. E. (2023). Evaluation of Pulmonary Fibrosis Outcomes by Race and Ethnicity in US Adults. In JAMA Network Open (Vol. 6, Issue 3, p. e232427). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.2427