The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population: A longitudinal study

David C. Taylor-Robinson, Rosalind L. Smyth, Peter J. Diggle, Margaret Whitehead

Research output: Contribution to journalArticle

Abstract

Background: Poorer socioeconomic circumstances have been linked with worse outcomes in cystic fibrosis. We assessed whether a relation exists between social deprivation and individual's clinical and health-care outcomes. Methods: We did a longitudinal registry study of the UK cystic fibrosis population younger than 40 years (8055 people with 49 337 observations for weight, the most commonly collected outcome, between Jan 1, 1996, and Dec 31, 2009). We assessed data for weight, height, body-mass index, percent predicted forced expiratory volume in 1 s (%FEV1), risk of Pseudomonas aeruginosa colonisation, and the use of major cystic fibrosis treatment modalities. We used mixed effects models to assess the association between small-area deprivation and clinical and health-care outcomes, adjusting for clinically important covariates. We give continuous outcomes as mean differences, and binary outcomes as odds ratios, comparing extremes of deprivation quintile. Findings: Compared with the least deprived areas, children from the most deprived areas weighed less (standard deviation [SD] score -0·28, 95% CI -0·38 to -0·18), were shorter (-0·31, -0·40 to -0·21, and had a lower body-mass index (-0·13, -0·22 to -0·04), were more likely to have chronic P aeruginosa infection (odds ratio 1·89, 95% CI 1·34 to 2·66), and have a lower %FEV1 (-4·12 percentage points, 95% CI -5·01 to -3·19). These inequalities were apparent very early in life and did not widen thereafter. On a population level, after adjustment for disease severity, children in the most deprived quintile were more likely to receive intravenous antibiotics (odds ratio 2·52, 95% CI 1·92 to 3·17) and nutritional treatments (1·78, 1·44 to 2·20) compared with individuals in the least deprived quintile. Patients from the most disadvantaged areas were less likely to receive DNase or inhaled antibiotic treatment. Interpretation: In the UK, children with cystic fibrosis from more disadvantaged areas have worse growth and lung function compared with children from more affluent areas, but these inequalities do not widen with advancing age. Clinicians consider deprivation status, as well as disease status, when making decisions about treatments, and this might mitigate some effects of social disadvantage.

Original languageEnglish (US)
Pages (from-to)121-128
Number of pages8
JournalThe Lancet Respiratory Medicine
Volume1
Issue number2
DOIs
StatePublished - Apr 2013
Externally publishedYes

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Cystic Fibrosis
Longitudinal Studies
Odds Ratio
Vulnerable Populations
Population
Body Mass Index
Anti-Bacterial Agents
Delivery of Health Care
Weights and Measures
Deoxyribonucleases
Forced Expiratory Volume
Therapeutics
Pseudomonas aeruginosa
Registries
Decision Making
Lung
Growth
Infection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population : A longitudinal study. / Taylor-Robinson, David C.; Smyth, Rosalind L.; Diggle, Peter J.; Whitehead, Margaret.

In: The Lancet Respiratory Medicine, Vol. 1, No. 2, 04.2013, p. 121-128.

Research output: Contribution to journalArticle

Taylor-Robinson, David C. ; Smyth, Rosalind L. ; Diggle, Peter J. ; Whitehead, Margaret. / The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population : A longitudinal study. In: The Lancet Respiratory Medicine. 2013 ; Vol. 1, No. 2. pp. 121-128.
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abstract = "Background: Poorer socioeconomic circumstances have been linked with worse outcomes in cystic fibrosis. We assessed whether a relation exists between social deprivation and individual's clinical and health-care outcomes. Methods: We did a longitudinal registry study of the UK cystic fibrosis population younger than 40 years (8055 people with 49 337 observations for weight, the most commonly collected outcome, between Jan 1, 1996, and Dec 31, 2009). We assessed data for weight, height, body-mass index, percent predicted forced expiratory volume in 1 s ({\%}FEV1), risk of Pseudomonas aeruginosa colonisation, and the use of major cystic fibrosis treatment modalities. We used mixed effects models to assess the association between small-area deprivation and clinical and health-care outcomes, adjusting for clinically important covariates. We give continuous outcomes as mean differences, and binary outcomes as odds ratios, comparing extremes of deprivation quintile. Findings: Compared with the least deprived areas, children from the most deprived areas weighed less (standard deviation [SD] score -0·28, 95{\%} CI -0·38 to -0·18), were shorter (-0·31, -0·40 to -0·21, and had a lower body-mass index (-0·13, -0·22 to -0·04), were more likely to have chronic P aeruginosa infection (odds ratio 1·89, 95{\%} CI 1·34 to 2·66), and have a lower {\%}FEV1 (-4·12 percentage points, 95{\%} CI -5·01 to -3·19). These inequalities were apparent very early in life and did not widen thereafter. On a population level, after adjustment for disease severity, children in the most deprived quintile were more likely to receive intravenous antibiotics (odds ratio 2·52, 95{\%} CI 1·92 to 3·17) and nutritional treatments (1·78, 1·44 to 2·20) compared with individuals in the least deprived quintile. Patients from the most disadvantaged areas were less likely to receive DNase or inhaled antibiotic treatment. Interpretation: In the UK, children with cystic fibrosis from more disadvantaged areas have worse growth and lung function compared with children from more affluent areas, but these inequalities do not widen with advancing age. Clinicians consider deprivation status, as well as disease status, when making decisions about treatments, and this might mitigate some effects of social disadvantage.",
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