Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in Idiopathic Pulmonary Fibrosis

Shankar, Rashmi, Hadinnapola, Charaka M., Clark, Allan B. ORCID: https://orcid.org/0000-0003-2965-8941, Adamali, Huzaifa, Chaudhuri, Nazia, Spencer, Lisa G. and Wilson, Andrew M. (2024) Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in Idiopathic Pulmonary Fibrosis. Respiratory Medicine. ISSN 0954-6111

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Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive condition associated with a variable prognosis. The relationship between socioeconomic status or distance travelled to respiratory clinics and prognosis is unclear. Research question: To determine whether socioeconomic status, distance to hospital and time to referral affects survival in patients with IPF. Study design and methods: In this retrospective cohort study, we used data collected from the British Thoracic Society Interstitial Lung Diseases Registry, between 2013 and 2021 (n = 2359) and calculated the quintile of Index of Multiple Deprivation 2019 score, time from initial symptoms to hospital attendance and distance as the linear distance between hospital and home post codes. Survival was assessed using Cox proportional hazards models. Results: There was a significant association between increasing quintile of deprivation and duration of symptoms prior to hospital presentation, Gender Age Physiology (GAP) index and receipt of supplemental oxygen and antifibrotic therapies at presentation. The most deprived patients had worse overall survival compared to least deprived after adjusting for smoking status, GAP index, distance to hospital and time to referral (HR = 1.39 [1.11, 1.73]; p = 0.003). Patients living furthest from a respiratory clinic also had worse survival compared to those living closest (HR = 1.29 [1.01, 1.64]; p = 0.041). Interpretation: The most deprived patients with IPF have more severe disease at presentation and worse outcomes. Living far from hospital was also associated with poor outcomes. This suggests inequalities in access to healthcare and requires consideration in delivering effective and equitable care to patients with IPF.

Item Type:	Article
Additional Information:	Data reporting: Data access for the British Thoracic Society Interstitial Lung Disease Registry is available at https://www.brit-thoracic.org.uk/quality-improvement/bts-clinical-data-policy-and-data-access/ Funding information: AW RS AC received funding from the University of East Anglia to undertake the study. Grant reference MED10 MR3. www.uea.ac.uk. The design, data collection, analysis, and reporting were performed independently by the authors.
Uncontrolled Keywords:	access to care,idiopathic pulmonary fibrosis,social class,socioeconomic status,survival,travelling distance
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Centres > Population Health Faculty of Medicine and Health Sciences > Research Groups > Respiratory and Airways Group Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Depositing User:	LivePure Connector
Date Deposited:	08 Apr 2024 10:30
Last Modified:	30 Apr 2024 14:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/94856
DOI:	10.1016/j.rmed.2024.107612

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