Disparities in Lung Transplant among Patients with Idiopathic Pulmonary Fibrosis: An Analysis of the IPF-PRO Registry. Journal Article

Local Library Link: Find It @ Loyola

Authors: Swaminathan, A; Hellkamp, AS; Neely, ML; Bender, S; Paoletti, L; White, ES; Palmer, SM; Whelan, TP; Dilling, DF
Article Title: Disparities in Lung Transplant among Patients with Idiopathic Pulmonary Fibrosis: An Analysis of the IPF-PRO Registry.
Abstract: RATIONALE: Lung transplantation offers the potential to extend life for patients with idiopathic pulmonary fibrosis (IPF), yet this therapeutic modality is only available to a small proportion of patients. OBJECTIVE: To identify clinical characteristics and social determinants of health that differentially associate with lung transplant compared with death in patients with IPF. METHODS: We evaluated data from the IPF-PRO Registry, a multi-center US registry of patients with IPF that was diagnosed or confirmed at the enrolling center in the previous 6 months. Patients were enrolled between June 2014 and October 2018. Patients who were listed for lung transplant were not eligible to enroll in the registry, but patients could be listed for transplant after enrollment. We performed a multivariable time-to-event analysis incorporating competing risks methodology to examine differential associations between pre-specified covariates and the risk of lung transplant versus death. Covariates included factors related to lung transplant eligibility, clinical characteristics of IPF, and social determinants of health. Covariates were modeled as time-independent or time-dependent as appropriate. RESULTS: Among 955 patients with IPF, event rates of lung transplant and death were 7.4% and 16.3%, respectively, at 2 years. Covariates with the strongest differential association were age, median ZIP code income, and enrollment at a center with a lung transplant program. Lung transplant was less likely (HR 0.13 [95% CI 0.06, 0.28] per 5-year increase) and death more likely (HR 1.41 [95% CI 1.22, 1.64] per 5-year increase) among those aged >70. Higher median ZIP code income was associated with lung transplant (HR 1.22 [95% CI 1.13, 1.31] per $10,000 increase) but not death (HR 0.99 [95% CI 0.94, 1.04] per $10,000 increase). Enrollment at a center with a lung transplant program was associated with lung transplant (HR 4.31 [95% CI 1.76, 10.54]) but not death (HR 0.99 [95% CI 0.69, 1.43]). Oxygen use with activity was associated with both lung transplant and death, but more strongly with lung transplant. A higher number of comorbidities associated with an increased likelihood of death but not lung transplant. CONCLUSIONS: For patients in the IPF-PRO Registry, median ZIP code income and access to a lung transplant center differentially impact the risk of lung transplantation compared with death, irrespective of disease severity measures or other transplant eligibility factors. Interventions are needed to mitigate inequalities in lung transplantation based on socioeconomic status. Clinical trial registered with ClinicalTrials.gov (NCT01915511).
Journal Title: Annals of the American Thoracic Society
ISSN: 2325-6621; 2325-6621
Publisher: Unknown  
Date Published: 2022