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Evaluating Outcomes Disparities in the Hispanic Cystic Fibrosis Population: A Need for a National Analysis FREE TO VIEW

Jason Rho, MD; Chul Ahn, PhD; Ang Gao, MS; Ashley Keller, MPH; Raksha Jain, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDivision of Pulmonary Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX

bDepartment of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX

CORRESPONDENCE TO: Raksha Jain, MD, 5323 Harry Hines Blvd, Campus Box 8558, Dallas, TX 75390


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):751-753. doi:10.1016/j.chest.2016.06.041
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In the February 2016 issue of CHEST, Buu and colleagues importantly shed light on outcomes disparities for Hispanic patients with cystic fibrosis (CF) in California over a 20-year span. This vulnerable, yet increasingly growing population, now represents 8.2% of patients with CF in the United States. Authors found Hispanic patients with CF had a 2.81 times higher rate of death compared with non-Hispanics yet similar lung function declines (FEV1), even when adjusting for important variables including insurance status, neighborhood median household income, bacterial infection, and CFTR genotype.

This study poses several interesting follow-up questions. Can these data pertain to the Hispanic population outside of California? From 2010 US Census data, Hispanics in the United States represent a heterogeneous ethnic group with different subgroups predominating in particular regions (eg, Mexicans in the south and west, Cubans in the southeast, Puerto Ricans in the northeast). Analyses of other geographic regions would help delineate whether this association of outcomes disparities in the Hispanic CF population exist outside of just one state’s population. Additionally, with similar lung function decline between the Hispanic and non-Hispanic population, what is contributing to this disparity?

After approval by the Institutional Review Board at the University of Texas Southwestern Medical Center (Institutional Review Board protocol STU 022015-002), we analyzed patients with CF seen at our center between 2010 and 2014. A total of 475 patients with CF were included in our analysis (Hispanics n = 63, 13.3%; Fig 1). Clinical outcomes measured were CF exacerbations and yearly decline in FEV1. Using the generalized estimating equation (a model used to analyze longitudinal, repeated measurement data to estimate the average response over a population), no significant difference in the rate of FEV1 yearly decline was seen between Hispanics and non-Hispanics (P = .27), even when controlling for the effect of age-at-encounter (P = .26). The total number of CF exacerbations between Hispanic and non-Hispanic cohorts demonstrated no statistically significant difference (P = .45, Table 1).

Figure Jump LinkFigure 1 CF patients seen at UT Southwestern Medical Center between 2010-2014. CF = cystic fibrosis; PFT = pulmonary function test; UT = University of Texas. aOf the 475 patients included in the study, 21 patients were transplanted between 2010-2014 and thus any data after their transplant date were omitted (Hispanic patients n = 1; non-Hispanic patients n = 20).Grahic Jump Location

Table Graphic Jump Location
Table 1 Demographics
a χ2 test.
b t test.
c Fisher exact test.
d Using generalized estimating equation.

Similar to the study by Buu et al, we did not find a statistical difference in lung function decline or the rate of CF exacerbations between Hispanic and non-Hispanic patients with CF. The Hispanic population in Texas includes a large population of Mexican Hispanic Americans, similar to California. Future studies should aim to include Hispanics from across the United States to determine if there are any geographic differences in this subpopulation of patients with CF.

References

Buu M.C. .Sanders L.M. .Mayo J.A. .Milla C.E. .Wise P.H. . Assessing differences in mortality rates and risk factors between Hispanic and non-Hispanic patients with cystic fibrosis in california. Chest. 2016;149:380-389 [PubMed]journal. [CrossRef] [PubMed]
 
Cystic Fibrosis Foundation Patient Registry 2014 Annual Data Report.  2015;:- [PubMed] Cystic Fibrosis Foundation Bethesda, MDjournal
 
United States Census Bureau. Hispanic population: 2010.http://wwwcensusgov/prod/cen2010/briefs/c2010br-04pdf. Accessed April 8, 2016.
 
Hanley J.A. .Negassa A. .Edwardes M.D. .Forrester J.E. . Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157:364-375 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 CF patients seen at UT Southwestern Medical Center between 2010-2014. CF = cystic fibrosis; PFT = pulmonary function test; UT = University of Texas. aOf the 475 patients included in the study, 21 patients were transplanted between 2010-2014 and thus any data after their transplant date were omitted (Hispanic patients n = 1; non-Hispanic patients n = 20).Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 Demographics
a χ2 test.
b t test.
c Fisher exact test.
d Using generalized estimating equation.

References

Buu M.C. .Sanders L.M. .Mayo J.A. .Milla C.E. .Wise P.H. . Assessing differences in mortality rates and risk factors between Hispanic and non-Hispanic patients with cystic fibrosis in california. Chest. 2016;149:380-389 [PubMed]journal. [CrossRef] [PubMed]
 
Cystic Fibrosis Foundation Patient Registry 2014 Annual Data Report.  2015;:- [PubMed] Cystic Fibrosis Foundation Bethesda, MDjournal
 
United States Census Bureau. Hispanic population: 2010.http://wwwcensusgov/prod/cen2010/briefs/c2010br-04pdf. Accessed April 8, 2016.
 
Hanley J.A. .Negassa A. .Edwardes M.D. .Forrester J.E. . Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003;157:364-375 [PubMed]journal. [CrossRef] [PubMed]
 
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