Racial disparities in pulmonary fibrosis outcomes

Pulmonary fibrosis involves progressive scarring of lung tissue that leads to difficulty breathing. wavebreakmedia / Shutterstock

Pulmonary fibrosis (PF) involves progressive scarring of lung tissue. The disease usually occurs in people older than 50. Smoking increases the risk for PF, but in many cases the cause of the disease isn’t known. There is no cure, and up to half of patients die within five years of diagnosis. Racial and ethnic minority groups generally face increased risks of illness and death due to health disparities. But in the case of PF, little has been known about whether the disease affects people from different racial and ethnic groups differently.

A team of researchers led by Dr. Ayodeji Adegunsoye at the University of Chicago Medical Center examined clinical outcomes for people of different racial and ethnic groups. The study included nearly 4,800 patients from various clinical registries. The patients were followed between January 2003 and April 2021. Findings appeared in JAMA Network Open on March 10, 2023.

The team found that the Black patients were diagnosed with PF when they were about 10 years younger than the White and Hispanic patients. More than two-thirds of the Black patients were women, compared with less than half of the White and Hispanic patients. Black patients also had twice as many hospitalizations per person as Hispanic or White patients. Black patients were first hospitalized at a younger age than Hispanic or White patients.

The age discrepancies persisted throughout the course of the disease. Black patients received lung transplants and died at younger ages than patients in the other groups. Death rates were lower in Black patients than White and Hispanic patients. But any benefits from this reduced mortality rate were likely offset by the younger age at diagnosis and death.

There are different subtypes of PF with different prognoses. The racial and ethnic groups differed in which subtypes were most prevalent. For example, White and Hispanic patients were most likely to have PF of unknown cause. Black patients were most likely to have a type of PF associated with connective tissue disease. The different prognoses for these subtypes may in part explain the observed differences in outcomes for the different groups.

Treatments differed as well. Black patients were more likely than the other groups to receive corticosteroid therapy, which can cause serious side effects. They were also less likely to receive antifibrotic therapy. These differences may be due in part to different treatment regimens for different PF subtypes.

The findings reveal significant racial disparities in PF diagnosis, treatment, and outcomes. They suggest a need for early screening in Black patients. Although there is no cure for PF, early detection and treatment can improve prognosis.

Further study will be needed to determine the causes of these disparities. But Adegunsoye suggests that lifestyle and socioeconomic factors may be at work. “For example, Black people are more likely to live along transit corridors, exposing them to more air pollution,” he says. “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.”

A better understanding of the causes of these racial disparities could lead to new interventions to prevent PF.

—by Brian Doctrow, Ph.D.