Pulmonary fibrosis is a devastating disease characterised by progressive scarring within the lungs, killing as much as half of patients inside five years of a diagnosis. Little is thought about whether there are differences in how the condition affects individuals of various ethnicities. Recent research on the University of Chicago Medicine has found that Black patients with pulmonary fibrosis are significantly younger than their Hispanic and white counterparts across a wide range of disease metrics, including diagnosis, first hospitalization, lung transplant and death.

“Pulmonary fibrosis is a virulent disease, and individuals are often diagnosed right across the time they retire,” said Ayodeji Adegunsoye, MD, MS, Assistant Professor of Medicine at UChicago Medicine and lead creator on the study, published March 10 in JAMA Network Open. “You may imagine how devastating it could be, to work diligently all of your life after which as you might be about to retire, you are diagnosed with a disease with a life expectancy of around three years. Anything that increases the mortality of this disease must be fastidiously examined.”

The study examined data from 4 geographically distinct hospitals across the U.S. and followed the outcomes for over 4,500 patients between January 2003 and April 2021. The outcomes found that Black patients were diagnosed with pulmonary fibrosis at a median age of 57.9 years, in comparison with 68.6 years for white patients. Black patients were also less prone to be male and more prone to be hospitalized in comparison with white and Hispanic patients, and were consistently younger on the time of their first hospitalization, lung transplant and death.

“I used to be driven to review this query through my work with patients with pulmonary fibrosis on the South Side of Chicago,” Adegunsoye said. “This disease has no clear cause and no cure, however it will not be a cancer; the poor prognosis made me wonder if Black patients are as affected by this disease as whites, and whether or not they experienced different outcomes. And we saw that Black patients’ experience with the disease is accelerated by about 10 years.”

Pulmonary fibrosis has been linked to quite a lot of risk aspects, including a rheumatoid arthritis diagnosis, exposure to air pollution, occupations that place a person at high risk of inhaling particulate matter and smoking. The researchers consider the disparities seen within the study are likely linked to lifestyle and socioeconomic aspects that put Black patients at a better risk of environmental exposures.

For instance, Black individuals are more prone to live along transit corridors, exposing them to more air pollution. They’re also more prone to be underinsured or uninsured. Being Black will not be the health risk; it is the environmental and societal aspects that make it difficult for Black patients to access high-quality care.”

Ayodeji Adegunsoye, MD, MS, Assistant Professor of Medicine at UChicago Medicine

The outcomes highlight the necessity for policy changes to lift awareness in regards to the risks and symptoms of the condition and to encourage prophylactic screenings when warranted. Adegunsoye pointed to recent changes within the recommendations for colorectal cancer screenings, spurred by research showing that Black patients were more prone to be diagnosed at a younger age.

“These results are so profound that I think we must always be screening everyone for pulmonary fibrosis earlier, especially if a patient has any risk aspects,” he said. “In case you can pick up the disease sooner, the outcomes will improve. We all know more in regards to the disease now than we did even 10 years ago, and while there isn’t a cure, there are treatments available -; a few of them are so simple as changing your environment or wearing a mask to scale back environmental exposure, but there are also drugs that may slow the progression of the disease.

“People must be aware that not every cough is an indication of pulmonary fibrosis, but patients and their care teams need to judge such symptoms fastidiously. The sooner we will intervene on this disease, the longer we can provide patients to enjoy their lives.”

Adegunsoye and his research team at the moment are investigating the molecular mechanisms and environmental exposures which may be contributing to the racial disparities seen within the study. Understanding how things reminiscent of pollution, food plan and stress can alter human biology may help make clear why and the way certain patients find yourself with pulmonary fibrosis, and whether there’s a possibility to intervene before it becomes deadly. Also they are investigating whether contracting COVID-19 places patients at a better risk of pulmonary fibrosis.

Outside of the lab, Adegunsoye says he simply wants patients to get what they need and after they need it, including understanding that protecting their lungs from pollutants and irritants is a simple step for stopping many forms of pulmonary fibrosis.

“Something so simple as wearing a mask should you’re working in a refinery or factory could help,” he said. “People should understand that respiratory clean air, so simple as it sounds, could make an enormous difference.”

Source:

University of Chicago Medical Center

Journal reference:

Adegunsoye, A., et al. (2023) Evaluation of Pulmonary Fibrosis Outcomes by Race and Ethnicity in US Adults. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.2427.