RT Journal Article
SR Electronic
T1 Relative environmental and social disadvantage in patients with idiopathic pulmonary fibrosis
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 1237
OP 1242
DO 10.1136/thoraxjnl-2021-217652
VO 77
IS 12
A1 Avitzur, Na'ama
A1 Noth, Elizabeth M
A1 Lamidi, Mubasiru
A1 Nathan, Steven D
A1 Collard, Harold R
A1 DeDent, Alison M
A1 Thakur, Neeta
A1 Johannson, Kerri A
YR 2022
UL http://thorax.bmj.com/content/77/12/1237.abstract
AB Background Air pollution exposure is associated with disease severity, progression and mortality in patients with idiopathic pulmonary fibrosis (IPF). Combined impacts of environmental and socioeconomic factors on outcomes in patients with IPF are unknown. The objectives of this study were to characterise the relationships between relative environmental and social disadvantage with clinical outcomes in patients with IPF.Methods Patients with IPF were identified from a longitudinal database at University of California, San Francisco. Residential addresses were geocoded and linked to the CalEnviroScreen 3.0 (CES), a tool that quantifies environmental burden in California communities, combining population, environmental and pollution vulnerability into individual and composite scores (higher scores indicating greater disadvantage). Unadjusted and adjusted linear and logistic regression and Fine and Gray proportional hazards models were used.Results 603 patients were included. Higher CES was associated with lower baseline forced vital capacity ( β =−0.073, 95% CI −0.13 to −0.02; p=0.006) and diffusion capacity of the lung for carbon monoxide ( β =−0.11, 95% CI −0.16 to −0.06; p<0.001). Patients in the highest population vulnerability quartile were less likely to be on antifibrotic therapy (OR=0.33; 95% CI 0.18 to 0.60; p=0.001) at time of enrolment, compared with those in the lowest quartile. An association between CES and mortality was suggested, but sensitivity analyses demonstrated inconsistent results. Relative disadvantage of the study cohort appeared lower compared with the general population.Conclusions Higher environmental exposures and vulnerability were associated with lower baseline lung function and lower antifibrotic use, suggesting that relative socioenvironmental disadvantage has meaningful impacts on patients with IPF.Data are available on reasonable request.