US Study: Living in Poorer Neighborhoods Linked to Worse Survival

People with idiopathic pulmonary fibrosis (IPF) who live in poorer neighborhoods are less likely to receive a lung transplant and have a higher mortality risk, a U.S. single-center study reports.

The study’s lead researcher said she was surprised the findings of “neighborhood-level disadvantage” reached significance given the relatively small number of patients involved. The findings highlight the need for further investigation, she said.

These results also support legislative and policy efforts to reduce the burden of poverty and its impact on IPF patient care, according to investigators.

Gillian Goobie, MD, a PhD candidate at the Graduate School of Public Health at the University of Pittsburgh, in Pennsylvania, presented the study’s findings at the American Thoracic Society 2021 International Conference, running May 14–19. Her presentation was titled “Neighborhood-Level Disadvantage Impacts Mortality and Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis”

While the exact causes of IPF remain unknown, research has shown that both environmental and occupational factors contribute to disease progression. People who are exposed to harmful airborne particles such as asbestos, silica, and wood chippings are more likely to develop interstitial lung disease (ILD) and IPF. Likewise, smoking and air pollution also increase the risk of IPF.

But social and economic factors are also known to impact the overall health outcome of patients with chronic diseases. However, the impact of neighborhood-level socioeconomic factors in IPF remains elusive.

To address this question, Goobie and her colleagues used a measure of neighborhood socioeconomic status called area deprivation index or ADI. It ranks neighborhood disadvantages, taking into consideration several parameters, including income, education, employment, and housing quality. Higher ADI scores are indicative of a greater degree of neighborhood-level disadvantage, indicating that residents live in poorer communities.

In total, the researchers analyzed data from 410 patients enrolled at the prospective University of Pittsburgh Simmons Center for Interstitial Lung Disease (ILD) Registry. The data were collected for almost 20 years, from March 2000 to January 2020. Their main goal was to explore the possible association between ADI and mortality.

The results revealed that people living in the more disadvantageous neighborhoods, as shown by a higher ADI quartile, had a 2.1 times higher risk of death than those from more prosperous neighborhoods (lower ADI quartile).

Moreover, people living in more disadvantageous neighborhoods were significantly less likely to receive a lung transplant. Indeed, their chances of receiving a lung transplant were found to be about half of those who lived in more favorable, or more affluent, neighborhoods.

“Our preliminary data from our single center study at the University of Pittsburgh indicates that neighborhood-level disadvantage may be associated with increased mortality and reduced odds of receiving a lung transplant in patients with IPF,” Goobie said in a press release.

Yet, no correlation was found between the place of death — home, hospital, hospice, or intensive care unit (ICU) — and ADI scores.

These findings suggest that ADI is a good indicator of socioeconomic status, and “can be used in the future to explore health disparities in the IPF patient population,” the researchers wrote.

According to the team, IPF patients who live in poorer neighborhoods may experience disparities in housing, poverty, employment, and education that may impact their care.

“I was surprised that we were able to find a significant impact of neighborhood-level disadvantage on survival in our relatively small cohort [group] of patients with IPF,” Goobie said.

“I am looking forward to validating these results in a larger and more diverse population of patients with IPF and other forms of fibrotic ILD,” she said.

These findings also support the potential of policies and legislation that promote more equitable environments and reduce the burden of poverty as a strategy to lessen the impact of chronic lung illnesses like IPF.

“I think there are substantial real-world implications of this research,” Goobie said. “With a disease like IPF, which has a very high mortality, we are more able to demonstrate the substantial impact that these neighborhood-level factors can have on survival and transplant outcomes.”