Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in idiopathic pulmonary fibrosis

Rashmi Shankar; Charaka M Hadinnapola; Allan B Clark; Huzaifa Adamali; Nazia Chaudhuri; Lisa G Spencer; Andrew M Wilson

doi:10.1016/j.rmed.2024.107612

Assessment of the impact of social deprivation, distance to hospital and time to diagnosis on survival in idiopathic pulmonary fibrosis

Respir Med. 2024 Apr 25:227:107612. doi: 10.1016/j.rmed.2024.107612. Online ahead of print.

Authors

Rashmi Shankar¹, Charaka M Hadinnapola², Allan B Clark¹, Huzaifa Adamali³, Nazia Chaudhuri⁴, Lisa G Spencer⁵, Andrew M Wilson⁶

Affiliations

¹ Norwich Medical School, University of East Anglia, Norwich, UK.
² Norwich Medical School, University of East Anglia, Norwich, UK; Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
³ Bristol Interstitial Lung Disease Service, Southmead General Hospital, Bristol, UK.
⁴ School of Medicine, Ulster University, Londonderry, UK.
⁵ Liverpool Regional Interstitial Lung Disease Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
⁶ Norwich Medical School, University of East Anglia, Norwich, UK; Department of Respiratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK. Electronic address: a.m.wilson@uea.ac.uk.

PMID: 38677526
DOI: 10.1016/j.rmed.2024.107612

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.

Keywords: Access to care; Idiopathic pulmonary fibrosis; Social class; Socioeconomic status; Survival; Travelling distance.