Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug 8;18(1):618.
doi: 10.1186/s12913-018-3407-0.

Disparities in pulmonary fibrosis care in the United States: an analysis from the Nationwide Inpatient Sample

Adam W Gaffney  1   2 , Steffie Woolhander  3 , David Himmelstein  3 , Danny McCormick  4   5
Affiliations

Disparities in pulmonary fibrosis care in the United States: an analysis from the Nationwide Inpatient Sample

Adam W Gaffney et al. BMC Health Serv Res. .

Abstract

Background: Idiopathic pulmonary fibrosis is a disease with high morbidity and mortality. Care for these patients, including lung transplantation, may provide significant benefits, but is resource-intensive and expensive. Disadvantaged patients with IPF may hence be at risk for receiving inferior care.

Methods: We analyzed data from the Nationwide Inpatient Sample, a database consisting of all hospitalizations from a 20% sample of US hospitals. We identified adults hospitalized with IPF between 1998 and 2011 using ICD-9 codes. We assessed the effect of insurance coverage and socioeconomic status (SES) on lung transplantation, a treatment that may improve survival. We also examined the effect of coverage and SES on mortality, as well as discharge to inpatient rehabilitation and receipt of a lung biopsy, two markers of the intensity of care delivered. We used multiple logistic regression to adjust for patient and hospital characteristics.

Results: We identified 148,877 hospitalizations that met our definition of pulmonary fibrosis. In the main adjusted analyses, hospitalizations of patients with Medicaid (OR 0.30, 95% CI 0.16-0.57) or no insurance (OR 0.22, 95% CI 0.07-0.72) were less likely to result in a lung transplantation compared to hospitalizations of those with non-Medicaid insurance. Those of lower SES were also less likely to undergo transplantation, while hospitalized patients with Medicaid and the uninsured were less likely to be discharged to inpatient rehabilitation or to receive a lung biopsy.

Conclusions: Among hospitalized patients with IPF, those with lower SES, Medicaid coverage and without insurance were less likely to receive several clinical interventions.

Keywords: Disparities; Idiopathic pulmonary fibrosis; Lung transplantation.

PubMed Disclaimer

Conflict of interest statement

This study received “exempt” status from the Institutional Review Board of the Cambridge Health Alliance. It is a study of a large, de-identified publicly-available database and hence does not constitute human subjects research.

NA

The authors report no conflicts of interests with any relevant commercial entities. Dr. McCormick receives research grant support from the National Institutes of Health but has not served as a paid or unpaid consultant, received honoraria, expert testimony or speakers’ fees, travel or accommodation payments (other than from non-commercial research grants), and has not received research funding from commercial entities. He has no relevant patents or patent applications to disclose.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of main study population formation with outcomes
See this image and copyright information in PMC

References

    1. Ungar WJ, Paterson JM, Gomes T, Bikangaga P, Gold M, To T. Kozyrskyj AL. Relationship of asthma management, socioeconomic status, and medication insurance characteristics to exacerbation frequency in children with asthma. Ann Allergy Asthma Immunol. 2011;106(1):17–23. doi: 10.1016/j.anai.2010.10.006. - DOI - PMC - PubMed
    1. Schraufnagel DE, Blasi F, Kraft M, Gaga M, Finn PW, Rabe KF; ATS/ERS Committee on Disparities in Respiratory Health: An official American Thoracic Society/European Respiratory Society policy statement: disparities in respiratory health. Am J Respir Crit Care Med. 2013;188(7):865–71. - PubMed
    1. Slatore CG, Au DH, Gould MK. An official American Thoracic Society systematic review: insurance status and disparities in lung cancer practices and outcomes. Am J Respir Crit Care Med. 2010;182(9):1195–1205. doi: 10.1164/rccm.2009-038ST. - DOI - PubMed
    1. Lederer DJ, Martinez FJ. Idiopathic pulmonary fibrosis. N Engl J Med. 2018;378(19):1811–1823. doi: 10.1056/NEJMra1705751. - DOI - PubMed
    1. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier J-F, Flaherty KR, Lasky JA, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788–824. doi: 10.1164/rccm.2009-040GL. - DOI - PMC - PubMed

MeSH terms