Pulmonary fibrosis is a devastating disease characterized by progressive scarring of the lungs, resulting in the death of up to half of patients within five years of diagnosis. Little is known about whether there are differences in how the condition affects individuals of different races. New University of Chicago Medicine research finds that black patients with pulmonary fibrosis are significantly younger than their Hispanic and white counterparts across a variety of disease measures, including diagnosis, first-time hospitalization, lung transplant and death.
said Ayodeji Adegunsoye, MD, MS, assistant professor of medicine at UChicago Medicine and lead author on the study, which was published March 10 in the journal JAMA Network is open. “You can imagine how devastating it would be, to work so hard your whole life and then when you’re about to retire, be diagnosed with a disease that has a life expectancy of about three years. Anything that increases the death rate from that disease needs to be carefully examined.”
The study examined data from four geographically distinct hospitals across the United States and tracked outcomes for more than 4,500 patients between January 2003 and April 2021. The results found that black patients were diagnosed with pulmonary fibrosis at an average age of 57.9 years, compared to 68.6 years for white patients. Black patients were less likely to be male and more likely to be hospitalized than white and Hispanic patients, and were almost always younger at the time of first hospitalization, lung transplantation and death.
“I was prompted to study this question by working with pulmonary fibrosis patients on the South Side of Chicago,” Adigunsoy said. “This disease has no apparent cause and no cure, but it is not cancer; the poor prognosis made me wonder whether black patients were affected by this disease as white people, and whether or not they experienced different outcomes. And we saw that patients experience the disease accelerate by about 10 years “.
Pulmonary fibrosis has been linked to a number of risk factors, including a diagnosis of rheumatoid arthritis, exposure to air pollution, occupations that put an individual at risk from inhaling particulate matter, and smoking. The researchers believe that the disparities seen in the study are likely related to lifestyle and socioeconomic factors that put black patients at greater risk for environmental exposure.
For example, black people are more likely to live along transit corridors, which exposes them to more air pollution. They are also more likely to be uninsured or underinsured. Being black is not a health risk; It is environmental and societal factors that make it difficult for black patients to obtain quality care.”
Ayodeji Adegunsoye, MD, MS, assistant professor of medicine at UChicago Medicine
The findings highlight the need for policy changes to raise awareness of the risks and symptoms of the condition and encourage preventive screenings when necessary. Adegunsoye pointed to recent changes in recommendations for colorectal cancer screenings, spurred by research showing black patients are more likely to be diagnosed at a younger age.
“These findings are so profound that I believe we should screen everyone for pulmonary fibrosis early, especially if the patient has any risk factors,” he said. “If you can catch the disease sooner, the outcomes will improve. We know more about the disease now than we did even 10 years ago, and while there is no cure, there are treatments available — some as simple as changing your environment or wearing a mask to reduce environmental exposure, but There are also medications that can slow the progression of the disease.
“People should be aware that not every cough is a sign of pulmonary fibrosis, but patients and their care teams need to carefully evaluate these symptoms. The earlier we can intervene in this disease, the longer we can give patients a chance to enjoy their lives.”
Adegunsoye and his research team are now investigating the molecular mechanisms and environmental exposures that may contribute to the racial disparities seen in the study. Understanding how things like pollution, diet and stress can alter human biology may help clarify why and how some patients develop pulmonary fibrosis, and whether there is a chance to intervene before it becomes fatal. They are also investigating whether infection with COVID-19 puts patients at greater risk of developing pulmonary fibrosis.
Outside of the lab, Adegunsoye says he simply wants patients to get what they need and when they need it, including understanding that protecting their lungs from pollutants and irritants is an easy step to preventing many types of pulmonary fibrosis.
“Something as simple as wearing a mask if you work in a refinery or a factory can help,” he said. “People need to understand that a breath of fresh air, as simple as it sounds, can make a huge difference.”
Adegunsoye, A., et al. (2023) Evaluation of pulmonary fibrosis outcomes by race and ethnicity in US adults. JAMA Network is open. doi.org/10.1001/jamanetworkopen.2023.2427.