Background For many diseases including cancer, the inequalities in key clinical outcomes are known to be wider in the economically disadvantaged Northern England (NE) compared to the more affluent South England (SE) (Shack, et al, 2008). This study aimed to investigate the North-South divide in demographic characteristics and clinical outcomes in cystic fibrosis (CF) patients in England.
Methods This was a cross-sectional study of patients with CF living in the SE and NE and registered on the UK CF Registry in 2010. Clinical data from Annual Review Encounter (ARE) of that year included demographics, prescription records and clinical outcomes: FEV1%predicted and chronic infections.
Descriptive statistics were adopted to summarise categorical and continuous outcomes. Wilcoxon test and t-test was used to compare continuous outcomes, while two-sample test for equality of proportions was used to compare prevalence of infections and drug use.
Results The study cohort included 1265 children and 1752 adults from SE and 1483 children and 1917 adults from NE. For children: lung function (FEV1%), adjusted for age and sex was significantly higher in SE (84.51% vs 81.57%, p < 0.01). However, rates of Pseudomonas aeuginosa, Burkholderia cepacia and MRSA were similar. Significantly higher proportions of patients were diagnosed before turning 3 months in the NE compared to SE (46.76% vs 42.43%). In adults: in the NE the BMI was higher 22.35 vs 21.99 (p < 0.01) as was the FEV1%p, adjusted for age and sex (66.73% vs 64.69%, p = 0.04). Patients in SE were more frequently prescribed mucolytics (Dornase Alfa and Hypertonic Saline). In NE they more frequently used chronic macrolides. There were higher rates of PA, Bcc and MRSA in NE. The rates of MSSA and NTM were higher in the SE.
Conclusions There is a north-south divide in demographic characteristics and clinical outcomes in cystic fibrosis (CF) patients in England. In SE children have higher lung function. However, adults in the NE seem to have higher lung function compared to adults in SE. A single year cohort is not sufficient to deduce if these differences affect longer-term outcomes, like survival and requires further investigation.
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