Racial and Ethnic Disparities in Idiopathic Pulmonary Fibrosis: A UNOS/OPTN Database Analysis

• Published in: American journal of transplantation Vol. 6; no. 10; pp. 2436 - 2442
• Main Authors: Lederer, D. J., Arcasoy, S. M., Barr, R. G., Wilt, J. S., Bagiella, E., D'Ovidio, F., Sonett, J. R., Kawut, S. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-10-2006; Blackwell
• Subjects: Biological and medical sciences; Cohort; diffuse parenchymal lung disease; Ethnicity; Female; Follow-Up Studies; forced vital capacity; Humans; Incidence; interstitial lung disease; Lung Transplantation; Male; Medical sciences; Middle Aged; Miscellaneous; Pneumology; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Pulmonary Fibrosis - epidemiology; Pulmonary Fibrosis - surgery; Racial Groups; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Risk Factors; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate - trends; United States - epidemiology; United States; diffuse parenchymal lung disease; Forced vital capacity; Transplantation; Homotransplantation; interstitial lung disease; Surgery; Cohort study; UNO; Race; Database; Graft; Interstitial; Public health; Diffuse; Lung disease; Ethnic origin; Respiratory disease; Idiopathic; Ethnic group; Pulmonary fibrosis; Treatment; Cohort; Analysis; lung transplantation; Disparity
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01480.x

We previously reported poorer survival among non‐Hispanic blacks and Hispanics with idiopathic pulmonary fibrosis (IPF) compared to non‐Hispanic whites at our center. In the current study, we hypothesized that these disparities would exist in a nationwide cohort of wait‐listed patients with IPF. We performed a retrospective cohort study of 2635 patients with IPF listed for lung transplantation between 1995 and 2003 at 94 transplant centers in the United States. The age‐adjusted mortality rate was higher among non‐Hispanic blacks [hazard ratio (HR) = 1.24, 95% confidence interval (CI) 1.06–1.45, p = 0.009] and Hispanics (HR = 1.29, 95% CI 1.06–1.56, p = 0.01) compared to non‐Hispanic whites. These findings persisted after adjustment for transplantation, medical comorbidities and socioeconomic status. Worse lung function at the time of listing appeared to explain some of these differences (HR for non‐Hispanic blacks after adjustment for forced vital capacity percent predicted = 1.16, 95% CI 0.98–1.36, p = 0.09; HR for Hispanics = 1.21, 95% CI 0.99–1.48, p = 0.056). In summary, black and Hispanic patients with IPF have worse survival than whites after listing for lung transplant.
This retrosepective analysis of patients listed for lung transplantation indicates that mortality among listed patients is higher among blacks and hispanics, in part due to worse lung function at the time of listing.