title: The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States.
abstract: There is considerable variability in the clinical course of disease in cystic fibrosis (CF). Although currently unidentified modifier genes might explain some of this heterogeneity, other factors are probably contributory. Socioeconomic status (SES) is an important predictor of health status in many chronic polygenic diseases, but its role in CF has not been systematically evaluated. We performed a historical cohort analysis of pediatric CF patients in the United States using National Cystic Fibrosis Foundation Patient Registry (NCFPR) data for 1986 to 1994, and used Medicaid status as a proxy for low SES. The adjusted risk of death was 3.65 times higher (95% confidence interval [CI]: 3.03 to 4.40) for Medicaid patients than for those not receiving Medicaid. The percent predicted FEV(1) of surviving Medicaid patients was less by 9.1% (95% CI: 6.9 to 11.2). Medicaid patients were 2.19 times more likely to be below the 5th percentile for weight (95% CI: 1.91 to 2.51) and 2.22 times more likely to be below the 5th percentile for height (95% CI: 1.95 to 2.52) than were non-Medicaid patients. Medicaid patients were 1.60 times more likely to require treatment for a pulmonary exacerbation (95% CI: 1.29 to 1.98). There was no difference in the number of outpatient clinic visits for Medicaid and non-Medicaid patients. We conclude that low SES is associated with significantly poorer outcomes in children with CF. Barriers in access to specialty health care do not seem to explain this difference. Further study is indicated to determine what adverse environmental factors might cluster in CF patients of low SES to cause worse outcomes.
authors.affiliation: Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1081, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Schechter
authors.forename: B J
authors.initials: BJ
authors.lastname: Shelton
authors.forename: P A
authors.initials: PA
authors.lastname: Margolis
authors.forename: S C
authors.initials: SC
authors.lastname: Fitzsimmons
mesh_terms: D002423:Cause of Death; D002648:Child; D016000:Cluster Analysis; D003550:Cystic Fibrosis / Q000150:complications / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D005260:Female; D005541:Forced Expiratory Volume; D005582:Foundations; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008484:Medicaid / Q000191:economics*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009017:Morbidity; D011203:Poverty / Q000191:economics*; D016016:Proportional Hazards Models; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014797:Vital Capacity