African-American race and mortality in interstitial lung disease: a multicentre propensity-matched analysis

• Published in: The European respiratory journal Vol. 51; no. 6; p. 1800255
• Main Authors: Adegunsoye, Ayodeji, Oldham, Justin M, Bellam, Shashi K, Chung, Jonathan H, Chung, Paul A, Biblowitz, Kathleen M, Montner, Steven, Lee, Cathryn, Hsu, Scully, Husain, Aliya N, Vij, Rekha, Mutlu, Gokhan, Noth, Imre, Churpek, Matthew M, Strek, Mary E
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society Journals Ltd 01.06.2018
• Subjects: Adult; African Americans; Aged; Cause of Death; Diagnosis; Female; Health risk assessment; Hospitalization - statistics & numerical data; Humans; Logistic Models; Lung diseases; Lung Diseases, Interstitial - ethnology; Lung Diseases, Interstitial - mortality; Male; Middle Aged; Mortality; Multivariate Analysis; Patients; Phenotypes; Propensity Score; Races; Regression analysis; Retrospective Studies; Sensitivity analysis; Survival; United States; United States
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/13993003.00255-2018

We studied whether African-American race is associated with younger age and decreased survival time at diagnosis of interstitial lung disease (ILD).We performed a multicentre, propensity score-matched analysis of patients with an ILD diagnosis followed at five US hospitals between 2006 and 2016. African-Americans were matched with patients of other races based on a time-dependent propensity score calculated from multiple patient, physiological, diagnostic and hospital characteristics. Multivariable logistic regression models were used. All-cause mortality and hospitalisations were compared between race-stratified patient cohorts with ILD, and sensitivity analyses were performed.The study included 1640 patients with ILD, 13% of whom were African-American, followed over 5041 person-years. When compared with patients of other races, African-Americans with ILD were younger at diagnosis (56 years 67 years), but in the propensity-matched analyses had greater survival (hazard ratio 0.46, 95% CI 0.28-0.77; p=0.003) despite similar risk of respiratory hospitalisations (relative risk 1.04, 95% CI 0.83-1.31; p=0.709), and similar GAP-ILD (gender-age-physiology-ILD) scores at study entry. Sensitivity analyses in a separate cohort of 9503 patients with code-based ILD diagnosis demonstrated a similar association of baseline demographic characteristics with all-cause mortality.We conclude that African-Americans demonstrate a unique phenotype associated with younger age at ILD diagnosis and perhaps longer survival time.