Racial and ethnic disparities in survival in lung transplant candidates with idiopathic pulmonary fibrosis.
Minority patients have worse outcomes than nonminority patients in a variety of pulmonary diseases. We aimed to compare the survival of Black and Hispanic patients to that of others with idiopathic pulmonary fibrosis (IPF). We performed a retrospective cohort study of patients with IPF who were evaluated for lung transplantation at our center. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare survival between groups. Black and Hispanic patients had spirometry, lung volumes and diffusion capacity that were similar to others, but had worse exercise capacity. Minority patients had a significantly increased risk of death compared to others independent of transplantation status (hazard ratio = 3.3, 95% CI 1.2-8.9, p = 0.02). Differences in exercise capacity, pulmonary hemodynamics and socioeconomic factors appeared to account for some of the differences in survival. Black and Hispanic patients with IPF had an increased risk of death following referral for lung transplantation. This finding may be due to differences in disease progression and/or differences in access to medical care among minority patients. Future studies should confirm our findings in a larger cohort. The elimination of racial and ethnic disparities in outcome should be a priority for clinicians and researchers in this field.
Lederer
D J
DJ
Department of Medicine, College of Physicians and Surgeon, Columbia University, New York, New York.
Caplan-Shaw
C E
CE
O'Shea
M K
MK
Wilt
J S
JS
Basner
R C
RC
Bartels
M N
MN
Sonett
J R
JR
Arcasoy
S M
SM
Kawut
S M
SM
D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D005006:Ethnicity; D005080:Exercise Test; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000601:surgery*; D044469:Racial Groups; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016019:Survival Analysis