New Effect+of+socioIeconomic+status+on+lung+func;on+in+the+UK+cys;c+fibrosis+popula;on+ · 2020....
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Background The rate of decline of FEV1 in people with cys;c fibrosis is one of the most important predictors of death. Low socioeconomic status has been linked with poor outcomes in CF in the US. We have explored, for the first ;me in a UKwide cohort, longitudinal rate of decline in FEV1 and its rela;onship with socioeconomic status (SES) and other risk factors. Effect of socioeconomic status on lung func;on in the UK cys;c fibrosis popula;on . D TaylorRobinson 1 , M Whitehead 1 , P Diggle 3 , R Smyth 2 . Division of Public Health 1 , School of Reproduc;ve and Developmental Medicine 2 , University of Liverpool, CHICAS Lancaster University 3 Methods We undertook a retrospec;ve longitudinal cohort study of 3587 people with cys;c fibrosis aged less than 20 years, and explored rela;onships between predicted FEV1 and SES, demographic characteris;cs, genotype and other clinical characteris;cs using the UK CF registry between 1995 and 2006. Mixed model linear regression analysis was used to es;mate the effect of fixed and ;mevarying covariates on the outcome mean % predicted FEV1 at age five (intercept) and the rate of lung func;on decline (slope). Census based indices of mul;ple depriva;on (IMD) linked to postcodes from the UK cons;tuent coun;es were used as small area exposure measures of SES. Conclusions Social depriva;on in the UK associated with worse lung func;on at age five and subsequently Unadjusted effect of other covariates on %predicted FEV1 Acknowledgements DTR ([email protected]) is supported by an MRC Popula;on Scien;st Award Equal distribu;on across depriva;on quin;les Sex and cohort effect corroborate previous studies Depriva;on quin;le 1 (least deprived) 2 3 4 5 (most deprived) N (%) 707 (19.7) 692 (19.3) 699 (19.5) 763 (21.3) 726 (20.2) Age at diagnosis (yrs) 1.5 1.4 1.5 1.6 1.5 Female (%) 329 (46.5) 317 (45.8) 312 (44.6) 356 (46.7) 347 (47.8) Final sample comprised of 15, 638 measures on 3587 individuals. IMD scores used to allocate each individual to a norma;ve depriva;on quin;le. There is a similar age at diagnosis and sex ra;o across quin;les. CF does not appear to discriminate by SES in terms of incidence. SEX Age % predicted FEV1 60 70 80 90 100 7 9 11 13 15 17 19 Male Female COHORT Age % predicted FEV1 60 70 80 90 100 7 9 11 13 15 17 19 Born 1990 Born 2000 PSEUDOMONAS Age % predicted FEV1 60 70 80 90 100 7 9 11 13 15 17 19 No pseudomonas Pseudomonas SCREENED Age % predicted FEV1 60 70 80 90 100 7 9 11 13 15 17 19 Not screened Screened Steeper decline in lung func;on associated with female sex, later birth cohorts, pseudomonas coloniza;on and individuals not screened for CF Covariate Point estimate Lower 95%CI Upper 95% CI P-value Female Intercept 2.298 0.397 4.200 0.018 Female Slope -0.442 -0.655 -0.229 0.000 10 year cohort Intercept -2.271 -4.477 -0.066 0.044 10 year cohort Slope 0.371 0.125 0.618 0.003 Most deprived quintile Slope -4.713 -7.888 -1.539 0.004 Pseudomonas Slope -0.924 -2.166 0.317 0.144 Pseudomonas Intercept -0.147 -0.280 -0.013 0.032 Cepacia Slope -3.259 -5.140 -1.378 0.001 Supplemental feed Intercept -0.433 -1.645 0.778 0.483 Supplemental feed Slope -0.145 -0.279 -0.011 0.034 CFRD Intercept -8.471 -12.680 -4.261 0.000 CFRD Slope 0.503 0.125 0.881 0.009 Pancreatic enzymes Intercept -1.231 -2.411 -0.051 0.041 No allele 1 Intercept 1.680 -2.436 5.796 0.424 No allele 2 Intercept 2.238 -1.745 6.222 0.271 Not typed Intercept -2.797 -9.491 3.898 0.413 No allele 1 Slope -0.157 -0.593 0.279 0.481 No allele 2 Slope -0.415 -0.834 0.004 0.052 Not typed Slope -0.131 -0.786 0.524 0.695 Screened Intercept -3.277 -5.965 -0.590 0.017 Screened Slope 0.482 0.178 0.785 0.002 White Intercept 4.537 1.137 7.936 0.009 Difference in popula;on mean FEV1 between most and least deprived is 4.71% 95%CI 7.8 to 1.5 (unadjusted) or 4.23% (95%CI 7.39 to 1.1) (adjusted for covariates). No significant difference in rate of decline. In the context of a universal healthcare system more deprived popula;ons in UK have a lower mean %FEV1 at age five, but there is no difference in the rate of decline subsequently Events in early life are determining the effect of SES on lung func7on when first measured at age five Longitudinal studies are required to explore mechanisms and media;ng factors, and iden;fy possible interven;ons %predicted FEV1 versus age at clinic visit Age % predicted FEV1 20 40 60 80 100 120 140 7 9 11 13 15 17 19 Least deprived quintile Most deprived quintile
Transcript of New Effect+of+socioIeconomic+status+on+lung+func;on+in+the+UK+cys;c+fibrosis+popula;on+ · 2020....
Background The rate of decline of FEV1 in people with cys;c fibrosis is one of the most important predictors of death.
Low socioeconomic status has been linked with poor outcomes in CF in the US.
We have explored, for the first ;me in a UK-‐wide cohort, longitudinal rate of decline in FEV1 and its rela;onship with socioeconomic status (SES) and other risk factors.
Effect of socio-‐economic status on lung func;on in the UK cys;c fibrosis popula;on .
D Taylor-‐Robinson1, M Whitehead1, P Diggle3, R Smyth2 .
Division of Public Health1, School of Reproduc;ve and Developmental Medicine2, University of Liverpool, CHICAS -‐ Lancaster University3
Methods
We undertook a retrospec;ve longitudinal cohort study of 3587 people with cys;c fibrosis aged less than 20 years, and explored rela;onships between predicted FEV1 and SES, demographic characteris;cs, genotype and other clinical characteris;cs using the UK CF registry between 1995 and 2006.
Mixed model linear regression analysis was used to es;mate the effect of fixed and ;me-‐varying covariates on the outcome mean % predicted FEV1 at age five (intercept) and the rate of lung func;on decline (slope).
Census based indices of mul;ple depriva;on (IMD) linked to postcodes from the UK cons;tuent coun;es were used as small area exposure measures of SES.
Conclusions
Social depriva;on in the UK associated with worse lung func;on at age five and subsequently
Unadjusted effect of other covariates on %predicted FEV1
Acknowledgements DTR ([email protected]) is supported by an MRC Popula;on Scien;st Award
Equal distribu;on across depriva;on quin;les
Sex and cohort effect corroborate previous studies
Depriva;on quin;le 1 (least deprived) 2 3 4
5 (most deprived)
N (%) 707 (19.7) 692 (19.3) 699 (19.5) 763 (21.3) 726 (20.2)
Age at diagnosis (yrs) 1.5 1.4 1.5 1.6 1.5
Female (%) 329 (46.5) 317 (45.8) 312 (44.6) 356 (46.7) 347 (47.8)
Final sample comprised of 15, 638 measures on 3587 individuals. IMD scores used to allocate each individual to a norma;ve depriva;on quin;le. There is a similar age at diagnosis and sex ra;o across quin;les. CF does not appear to discriminate by SES in terms of incidence.
SEX
Age
% p
redi
cted
FEV
1
6070
8090
100
7 9 11 13 15 17 19
MaleFemale
COHORT
Age
% p
redi
cted
FEV
1
6070
8090
100
7 9 11 13 15 17 19
Born 1990Born 2000
PSEUDOMONAS
Age
% p
redi
cted
FEV
1
6070
8090
100
7 9 11 13 15 17 19
No pseudomonasPseudomonas
SCREENED
Age
% p
redi
cted
FEV
1
6070
8090
100
7 9 11 13 15 17 19
Not screenedScreened
Steeper decline in lung func;on associated with female sex, later birth cohorts, pseudomonas coloniza;on and individuals not screened for CF
Covariate Point
estimate Lower 95%CI
Upper 95% CI P-value
Female Intercept 2.298 0.397 4.200 0.018 Female Slope -0.442 -0.655 -0.229 0.000 10 year cohort Intercept -2.271 -4.477 -0.066 0.044 10 year cohort Slope 0.371 0.125 0.618 0.003 Most deprived quintile Slope -4.713 -7.888 -1.539 0.004 Pseudomonas Slope -0.924 -2.166 0.317 0.144 Pseudomonas Intercept -0.147 -0.280 -0.013 0.032 Cepacia Slope -3.259 -5.140 -1.378 0.001 Supplemental feed Intercept -0.433 -1.645 0.778 0.483 Supplemental feed Slope -0.145 -0.279 -0.011 0.034 CFRD Intercept -8.471 -12.680 -4.261 0.000 CFRD Slope 0.503 0.125 0.881 0.009 Pancreatic enzymes Intercept -1.231 -2.411 -0.051 0.041 No allele 1 Intercept 1.680 -2.436 5.796 0.424 No allele 2 Intercept 2.238 -1.745 6.222 0.271 Not typed Intercept -2.797 -9.491 3.898 0.413 No allele 1 Slope -0.157 -0.593 0.279 0.481 No allele 2 Slope -0.415 -0.834 0.004 0.052 Not typed Slope -0.131 -0.786 0.524 0.695 Screened Intercept -3.277 -5.965 -0.590 0.017 Screened Slope 0.482 0.178 0.785 0.002
White Intercept 4.537 1.137 7.936 0.009
Difference in popula;on mean FEV1 between most and least deprived is -‐4.71% 95%CI -‐7.8 to -‐1.5 (unadjusted) or -‐4.23% (95%CI -‐7.39 to -‐1.1) (adjusted for covariates). No significant difference in rate of decline.
In the context of a universal healthcare system more deprived popula;ons in UK have a lower mean %FEV1 at age five, but there is no difference in the rate of decline subsequently
Events in early life are determining the effect of SES on lung func7on when first measured at age five Longitudinal studies are required to explore mechanisms and media;ng factors, and iden;fy possible interven;ons
%predicted FEV1 versus age at clinic visit
Age
% p
redi
cted
FE
V1
2040
6080
100
120
140
7 9 11 13 15 17 19
Least deprived quintileMost deprived quintile
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