期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 184, 期 7, 页码 842-847出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.201104-0668OC
关键词
access to healthcare; healthcare disparities; idiopathic pulmonary fibrosis; interstitial lung disease; survival
资金
- NIH [K23 HL086714, KL2 RR024156]
- Robert Wood Johnson Physician Faculty Scholars Program
- Herbert and Florence Irving Scholar Award
- National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) [KL2 RR024156]
- NIH Roadmap for Medical Research
- Bayer
- Gilead
- Pfizer
- American Lung Association
- Novartis
- Actelion
- United Therapeutics
- Lung Rx
- Merck
- Robert Wood Johnson Foundation
Rationale: Idiopathic pulmonary fibrosis is often initially misdiagnosed. Delays in accessing subspecialty care could lead to worse outcomes among those with idiopathic pulmonary fibrosis. Objectives: To examine the association between delayed access to subspecialty care and survival time in idiopathic pulmonary fibrosis. Methods: We performed a prospective cohort study of 129 adults who met American Thoracic Society criteria for idiopathic pulmonary fibrosis evaluated at a tertiary care center. Delay was defined as the time from the onset of dyspnea to the date of initial evaluation at a tertiary care center. We used competing risk survival methods to examine survival time and time to transplantation. Measurements and Main Results: The mean age was 63 years and 76% were men. The median delay was 2.2 years (interquartile range 1.0-3.8 yr), and the median follow-up time was 1.1 years. Age and lung function at the time of evaluation did not vary by delay. A longer delay was associated with an increased risk of death independent of age, sex, forced vital capacity, third-party payer, and educational attainment (adjusted hazard ratio per doubling of delay was 1.3, 95% confidence interval 1.03 to 1.6). Longer delay was not associated with a lower likelihood of undergoing lung transplantation. Conclusions: Delayed access to a tertiary care center is associated with a higher mortality rate in idiopathic pulmonary fibrosis independent of disease severity. Early referral to a specialty center should be considered for those with known or suspected interstitial lung disease.
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