1. In this retrospective cohort study, Black patients with pulmonary fibrosis (PF) were found to have a younger age of diagnosis, first hospitalization, lung transplant, and death when compared with Hispanic and White patients.

2. Black patients were found to have a lower crude mortality rate ratio when compared to White and Hispanic patients.

Evidence Rating Level: 2 (Good)

Recently, death rates from chronic respiratory diseases have recently increased, largely driven by the rising burden of interstitial lung diseases (ILD). Pulmonary fibrosis (PF), a form of ILD, accounts for the highest increase in mortality rates. Racial and ethnic minority populations face the greatest risk of morbidity and mortality from health disparities; Black patients have high rates of respiratory impairment and may have differential survival in ILD when compared to White individuals. This study sought to evaluate the age of PF-related outcomes and the survival patterns among White, Black, and Hispanic participants with PF. This cohort study was conducted using the Pulmonary Fibrosis Foundation (PFF) patient registry as the primary cohort, containing data on more than 2000 patients across the United States. Outcomes included clinically relevant milestones of ILD, including diagnosis, hospitalizations, lung transplant, and all-cause mortality. In total, 5275 patients with a diagnosis of PF were included from January 2003 to April 2001. There were 488 (10.2%) Black patients, 318 (6.7%) Hispanic patients, and 3985 (83.2%) White patients. At study enrollment, Black patients with PF were least likely to be male and had the highest body mass index, while Hispanic and White patients were predominantly male. With respect to outcomes, Black patients had a lower crude mortality rate ratio when compared to White patients (P<.001), while Hispanic patients had a similar mortality rate ratio to White patients. Mean hospitalization events per person were highest among Black patients when compared with Hispanic and White patients (P<.001). Black patients generally had the youngest mean age at first hospitalization, lung transplant, and death with PF when compared to Hispanic and White patients (P<.001). Overall, this study demonstrated racial and ethnic disparities in PF outcomes; notably, Black patients with PF were diagnosed and hospitalized, underwent lung transplants, and died at a younger age than White and Hispanic patients. Mortality rates appeared to be lower in Black individuals than Hispanic and White individuals. A major limitation of this study is that differences in ILD subgroups (i.e., connective tissue-related versus idiopathic) may influence the prevalence of hospitalizations and lung transplants. Further research is required to identify and mitigate underlying responsible factors for this racial and ethnic disparity.

Click to read the study in JAMA Network Open

Image: PD

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