Disease course of PF accelerated in Black patients in US, study finds
Black patients affected by racial disparity in healthcare and socioeconomics
Black patients with pulmonary fibrosis (PF) are diagnosed around a decade earlier than their white counterparts in the U.S., a new study reports.
They also tend to be hospitalized more often and at younger ages compared with white or Hispanic patients, and were significantly younger at time of death, results suggest.
“We saw that Black patients’ experience with the disease is accelerated by about 10 years,” Ayodeji Adegunsoye, MD, an assistant professor at the University of Chicago and the study’s first author, said in a press release.
“These results are so profound that I believe we should be screening everyone for pulmonary fibrosis earlier, especially if a patient has any risk factors,” Adegunsoye said. “If you can pick up the disease sooner, the outcomes will improve. We know more about the disease now than we did even 10 years ago, and while there is no cure, there are treatments available.”
The study, “Evaluation of Pulmonary Fibrosis Outcomes by Race and Ethnicity in US Adults,” was published in JAMA Network Open.
Racial/ethnic minorities in U.S. tend to fare worse across healthcare outcomes
It is well-documented that Black people and other racial/ethnic minorities in the U.S. tend to fare worse across a wide range of healthcare-related outcomes. However, there hasn’t been much research into racial and ethnic disparities in the context of PF.
“I was driven to study this question through my work with patients with pulmonary fibrosis on the South Side of Chicago,” Adegunsoye said. “The poor prognosis made me wonder if Black patients are as affected by this disease as whites, and whether or not they experienced different outcomes.”
To learn more, Adegunsoye and colleagues analyzed data from the Pulmonary Fibrosis Foundation (PFF) patient registry and information collected from several specialty care centers.
The study included data for 4,792 people with PF who were followed from 2003 to 2021. Among the patients, 10.2% were identified as Black, 6.7% as Hispanic, and 83.2% as white.
Researchers noted that, while more than half of Hispanic and white patients were male, about two-thirds of Black patients were female. Types of lung disease also varied by race: Black patients were more likely to have connective tissue disease-associated interstitial lung disease or unclassifiable forms of PF, while white patients were more commonly diagnosed with idiopathic pulmonary fibrosis.
Being Black is not the health risk; it’s the environmental and societal factors that make it difficult for Black patients to access high-quality care.
Black patients diagnosed about 10 years earlier than white or Hispanic patients
Black patients were diagnosed with PF and enrolled in the PFF registry about 10 years earlier than white (mean age of 57.9 vs. 68.6 years) or Hispanic patients (mean age of 57.9 vs. 65.4 years).
Similarly, Black patients were significantly younger at the time they were first hospitalized due to PF (mean of 59.4 years) compared with white (mean of 70 years) or Hispanic patients (mean of 67.5 years). Rates of hospitalization were also notably higher for Black patients.
Mortality data suggested that Black patients tended to live with PF for slightly longer than white or Hispanic patients. Nonetheless, with the dramatic differences in age at the time of disease onset and hospitalization, the mean age at the time of death was significantly younger for Black patients (68.7 years) compared with white (73.5 years) or Hispanic patients (72.9 years).
The fact that mean age at diagnosis, hospitalization, and death for Hispanic patients tended to fall between those of Black and white patients “may have resulted from their ethnic categorization as distinct from race,” the researchers wrote, “since these patients may have been Black Hispanic or White Hispanic patients.”
“The disparities in age were pervasive and ran through the natural history of PF from diagnosis through disease progression, culminating in early occurrence of hospitalization, lung transplant, and death among racial and ethnic minority populations,” the researchers wrote.
Findings emphasize importance of PF screening in minority communities
The team noted that more research is needed to understand the reasons for these disparities in detail, but they highlighted several factors that likely play a role.
“For example, Black people are more likely to live along transit corridors, exposing them to more air pollution,” Adegunsoye said. “They’re also more likely to be underinsured or uninsured. Being Black is not the health risk; it’s the environmental and societal factors that make it difficult for Black patients to access high-quality care.”
The team said that the findings emphasize the importance of PF screening in minority communities, so that a diagnosis can be made as quickly as possible. This is key, since an early diagnosis and timely treatment can lead to better outcomes.
“People should be aware that not every cough is a sign of pulmonary fibrosis, but patients and their care teams need to evaluate such symptoms carefully,” Adegunsoye said. “The earlier we can intervene in this disease, the longer we can give patients to enjoy their lives.”