Low socioeconomic status tied to worse IPF patient outcomes in UK
Social deprivation, distance from hospital found to contribute to poor health
In the U.K., patients with idiopathic pulmonary fibrosis (IPF) who live in economically deprived neighborhoods have worse survival outcomes than those living in more affluent areas, according to a recent study.
The study also found that patients who live farther away from specialty care centers tend to have worse survival outcomes than those who live near such centers.
“This is the first time that social deprivation and travelling distance to hospital has been linked to survival for people with pulmonary fibrosis living in the UK,” Andrew Wilson, MD, a professor at the University of East Anglia’s Norwich Medical School and study author, said in a university news story.
“People planning hospital services for people for pulmonary fibrosis should consider those living far from hospitals and those from poorer backgrounds to make sure these people get the care they need,” Wilson said.
The study, “Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in idiopathic pulmonary fibrosis,” was published in the journal Respiratory Medicine.
Socioeconomic status can have profound effects on healthcare outcomes
Socioeconomic status has profound effects on healthcare outcomes, but the specific effects on people with IPF living in the U.K. haven’t been rigorously studied. This is particularly noteworthy since the U.K., unlike other countries such as the U.S., has a publicly funded universal healthcare system that should in theory help mitigate the barrier posed by economic status in accessing healthcare.
In the study, researchers analyzed data on 2,359 people with IPF collected from 2013 to 2021 from the British Thoracic Society Interstitial Lung Disease Registry with the goal of assessing whether socioeconomic status and other geographic factors influenced patients’ survival outcomes.
For each patient, the researchers calculated a deprivation index, which is basically a numeric measure of socioeconomic status for the person’s neighborhood. Using this index, the researchers divided patients into quintiles — five equally-sized groups — from most deprived (bottom quintile) to most affluent. They then used statistical analyses to compare outcomes between the top and bottom quintiles.
Results showed patients in the bottom quintile had significantly worse survival outcomes.
Researchers noted that patients with high deprivation scores tended to wait longer to be evaluated by a clinician from the time they started experiencing symptoms, and generally had more severe disease by the time they were diagnosed.
Patients with higher deprivation scores were also more likely to be current or former smokers, referred for pulmonary rehabilitation, and prescribed antifibrotic treatments.
Patients with low socioeconomic status at higher risk
However, in statistical models that adjusted data to take into account factors such as smoking status and distance to specialty care, patients in the bottom quintile were found to be at a 39% increased risk of death compared with those in the top quintile.
“In this large national cohort of patients diagnosed with IPF we demonstrate that socioeconomic deprivation was independently associated with death in a universal healthcare system,” the scientists wrote, noting the findings “suggest that social deprivation exerts its effects on poor outcomes in addition to that of access to care.”
In a similar manner, the researchers also compared the outcomes for patients who lived closer or farther away from specialty care. Results showed patients who lived farthest had a significantly higher risk of death — 29% higher according to statistical analyses that took into account multiple factors — compared with those who lived closest.
Models also showed that, after adjusting for other factors, survival outcomes tended to be worse in patients who had a longer delay between first noticing symptoms and being evaluated by a specialist.
“Social deprivation, travelling distance and time to referral all contribute to … overall poor outcomes,” the researchers wrote, adding that “all of these elements need to be addressed” to improve IPF care for all patients.
Where you live or your socioeconomic status should not determine how long you live.
Bradley Price, director of policy and public affairs at Action For Pulmonary Fibrosis — a U.K. charity focused on helping people with IPF and other types of pulmonary fibrosis — said these outcomes are “unacceptable.”
“Where you live or your socioeconomic status should not determine how long you live,” Price said. “Change is needed to ensure that everyone has timely access to diagnosis, treatment and care.”
Action For Pulmonary Fibrosis is currently running a campaign called OneVoiceILD to build a network of clinicians to improve pulmonary fibrosis care in the U.K.
“A regional integrated approach with more specialist centres, as outlined in [OneVoiceILD’s] integrated care pathway, would go some way in reducing some of the factors outlined in this publication,” Price said.
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