June 25, 2019
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IPF mortality varies according to demographic characteristics

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The rates of idiopathic pulmonary fibrosis-related mortality differ significantly based on sex, race and age, according to a study published in the American Journal of Respiratory and Critical Care Medicine.

The researchers included 401,567 records of adults who died of IPF from 2000 to 2017. The overall age-adjusted mortality rate was 18.81 per 100,000 persons in 2000 and 20.66 per 100,000 in 2017, with regression analysis demonstrating a positive temporal trend during the study period (P < .0001).

When analyzed according to sex, there was a positive temporal trend during the study period for men (P < .0001), but the trend was not statistically significant among women. Further, across all racial subgroups, overall mortality rates were higher among men than women (OR = 1.63; 95% CI, 1.6-1.66).

Mortality also varied according to race during the study period. The researchers found a positive temporal trend among white adults (P < .0001) and a nonsignificant trend among American Indian/Alaska Native adults. Among Asian/Pacific Islander and black/African American adults, however, results demonstrated a negative temporal trend for the study period (P < .0001).

The researchers used the mortality rate among white adults (20.76 per 100,000 persons) as the reference, as this group accounted for the most IPF-related deaths overall. The mortality rate, however, was highest among American Indian/Alaska Native adults (26.57 per 100,000 persons; OR = 1.28; 95% CI, 1.26-1.3). Again, the overall mortality rate was lower among black/African American adults (OR = 0.56; 95% CI, 0.55-0.57) and Asian/Pacific Islander adults (OR = 0.64; 95% CI, 0.63-0.66).

Mortality rates also increased with age, ranging from 1.29 per 100,000 in adults aged 45 to 54 years to 85.69 per 100,000 in those older than 85 years. The differences in mortality rates according to race were consistent in the all-ages analysis.

For the study, the researchers used national death certification data from the U.S. National Vital Statistics System to analyze IPF mortality rates from 2000 to 2017. Cases containing ICD-10 codes for pulmonary fibrosis were included and records containing ICD-10 codes for diseases known to have a component of pulmonary fibrosis were excluded. Because IPF is rare in younger populations, only records for decedents aged 45 years and older were included in the analysis. Age-adjusted mortality rates were obtained from CDC WONDER.

“These mortality trends have occurred in the context of changing IPF diagnostic and treatment guidelines. Given the current understanding of IPF pathogenesis is incomplete, it would not be possible to control for the impact that changes in guidelines have on disease rates at this time. That being said, it is possible that the mortality trends are related to improved recognition and diagnosis of the disease. If disease prevalence itself is increasing among certain groups, this could be related to a number of genetic, environmental or behavioral factors,” the researchers wrote. – by Melissa Foster

Disclosures: Healio Pulmonology could not confirm the authors’ relevant financial disclosures at the time of publication.