Diffuse Lung Disease: Care of the Patient with IPF |

Longitudinal Changes in Comorbidity Rates in Patients With Idiopathic Pulmonary Fibrosis: Analysis of Medicare Data FREE TO VIEW

John Stauffer; Michael Broder; Eunice Chang; Elya Papoyan; Ioana Popescu; Sheila Reddy; Karina Raimundo
Author and Funding Information

Genentech, Inc., South San Francisco, CA

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

Chest. 2016;150(4_S):470A. doi:10.1016/j.chest.2016.08.484
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SESSION TITLE: Care of the Patient with IPF

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 08:45 AM - 10:00 AM

PURPOSE: Idiopathic pulmonary fibrosis (IPF) is associated with an increased risk of multiple comorbidities. Little is known about these relationships in the Medicare population. The objective of this analysis was to determine the longitudinal change in comorbidity rates of Medicare patients with IPF compared with matched controls.

METHODS: A retrospective analysis of Medicare data for patients aged ≥ 65 years in the US who were newly diagnosed with IPF in 2010 (ICD-9-CM code 516.3) and who lacked indication of a non-IPF ILD after the last observed IPF claim compared with disease-free (non-IPF) controls was performed. Patients were matched 1:1 on age, sex and region. Disease-free data were obtained from the 5% sample data set. Medicare enrollment was continuous the year before diagnosis (index date). Patients were followed for ≤ 4 years post-index; ≥ 1 year of continuous enrollment after the index date was required unless patients died within 1 year. Comorbidities at baseline and at 1 and 4 years post-index were reported for IPF and control groups.

RESULTS: 13,615 patients with IPF and their matched controls were identified. Mean age (SD) in the groups was 78.9 years (7.1); 50.3% were men. Patients with IPF had significantly more chronic conditions (mean [SD], 6.3 [2.2] vs. 4.7 [2.4]; P < 0.001) and a higher Charlson Comorbidity Index at baseline compared with controls (mean [SD], 3.6 [2.9] vs. 2.3 [2.7]; P < 0.001). Baseline rates of all comorbidities were significantly higher among patients with IPF vs. controls: COPD including emphysema (51.7% vs. 15.8%), bacterial pneumonia (31.4% vs. 6.9%), gastroesophageal reflux (30.9% vs. 18.6%), obstructive sleep apnea (8.3% vs. 2.7%), obesity (6.9% vs. 4.1%), lung cancer (3.7% vs. 1.8%), pneumothorax (0.3% and 0.1%) and cardiovascular conditions (67.6% vs. 44.2%); all P < 0.001. In the 1- and 4-year post-index periods, comorbidity rates were progressively higher among patients with IPF compared with controls: COPD including emphysema (1 y, 61.1% vs. 16.5%; 4 y, 72.4% vs. 26.9%), bacterial pneumonia (1 y, 38.4% vs. 9.8%; 4 y, 55.6% vs. 21.4%), gastroesophageal reflux (1 y, 33.9% vs. 18.5%; 4 y, 48.3% vs. 33.8%), obstructive sleep apnea (1 y, 11.7% vs. 3.2%; 4 y, 17.3% vs. 6.8%), obesity (1 y, 8.2% vs. 4.3%; 4 y, 14.4% vs. 10.3%), lung cancer (1 y, 5.6% vs. 2.2%; 4 y, 8.0% vs. 3.7%), pneumothorax (1 y, 0.5% vs. 0.1%; 4 y, 2.2% vs. 0.8%) and cardiovascular conditions (1 y, 74.3% vs. 46.4%; 4 y, 84.6% vs. 61.7%); all P < 0.001. The difference between comorbidity event rates for IPF and control groups increased at 1 year post-index compared with baseline; a larger difference between groups was observed at 4 years.

CONCLUSIONS: Comorbidity rates were significantly higher in newly diagnosed patients with IPF compared with matched patients without IPF in the Medicare population at baseline and became progressively higher over 4 years of follow-up; furthermore, the difference in comorbidity rates between the 2 groups became greater over time.

CLINICAL IMPLICATIONS: The higher comorbidities rates in newly diagnosed and surviving patients with IPF should be taken into consideration in their overall clinical management plan.

DISCLOSURE: John Stauffer: Employee: Genentech, Inc. Michael Broder: Employee: Partnership for Health Analytic Research, LLC. Eunice Chang: Employee: Partnership for Health Analytic Research, LLC. Elya Papoyan: Employee: Partnership for Health Analytic Research, LLC. Ioana Popescu: Employee: Phar LLC. Sheila Reddy: Employee: Partnership for Health Analytic Research, LLC. Karina Raimundo: Employee: Genentech, Inc.

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