By Adam W. Gaffney, M.D., M.P.H. and Anna J. Podolanczuk, M.D.
American Journal of Respiratory and Critical Care, January 6, 2022
If two patients, one poor and one wealthy, have the same fibrosing interstitial lung disease (fILD), could differential access to quality healthcare determine which one lives, and which one dies? A study published in this issue of the Journal suggests that it may — but also that such inequity is not inevitable.
In a provocative analysis, here, Goobie and colleagues provide the first transnational comparison of outcomes among individuals with this serious progressive condition, which requires multi-disciplinary evaluation, expensive therapies and vigilant monitoring.(1- 3) They assessed the effects of patients’ socioeconomic status — which they estimated based on a neighborhood-level metric of socioeconomic deprivation — on their outcomes, including mortality, lung transplantation, and lung function. Among US patients with fILD, they identified a striking mortality gap: death rates were 51% higher for those living in the most deprived quartile of neighborhoods relative to those in the least deprived quartile (95% CI 1.17, 1.95). No such disparity was present among Canadians with fILD. While lung transplant rates for all clinical conditions combined showed no consistent socioeconomic gradient in either nation, US patients with IPF residing in the most deprived quartile of neighborhoods were 64% less likely to have a lung transplant relative to those in the least deprived neighborhoods — a disparity that was not apparent among Canadians with IPF.