Abstract
Objective: To determine whether previously reported socioeconomic status (SES)-related disparities in cystic fibrosis (CF) health outcomes vary by the indicator used (median household income by zip code [MIZ], maternal educational attainment [MEA], and state insurance coverage [MA]), and whether these disparities can be explained by differences in medical treatment. Study design: A cross-sectional analysis of data on patients age <18 years from the Epidemiologic Study of Cystic Fibrosis (ESCF). Results: Disease severity showed a similar inverse correlation with all 3 SES measures. The number of stable clinic visits was unrelated to SES. Patients with MA had more sick outpatient visits and more courses of intravenous (IV) antibiotics for pulmonary exacerbations, and were more likely to be prescribed all chronic therapies. Low-MIZ patients had slightly fewer sick visits and more courses of IV antibiotics, and were more likely to receive oral nutrition supplements but less likely to receive macrolide prescriptions. Low-MEA patients were less likely to receive IV antibiotics at home, more likely to receive oral nutrition supplements, but less likely to receive macrolide prescriptions. Conclusions: CF health outcomes are correlated with the SES spectrum, but these disparities are not explained by differential use of health services or prescription of chronic therapy. Future investigations should focus on the possible impact of environmental exposures and differences in disease self-management.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 634-639.e4 |
| Journal | journal of pediatrics |
| Volume | 155 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2009 |
Funding
We thank David J. Pasta, MS (ICON Clinical Research, Inc, funded by Genentech) for providing biostatical and analytical services. We gratefully acknowledge the participation of the more than 400 ESCF site investigators and coordinators in collecting this comprehensive database, and the helpful discussions with members of the North American Scientific Advisory Group for ESCF ( Appendix 1 ). M.S.S., S.A.M., M.W.K., and J.S.W. have received honoraria during the last 3 years to attend meetings as members of the North American Scientific Advisory Group for the Epidemiologic Study of Cystic Fibrosis (ESCF), and their respective institutions previously received grant support from Genentech, Inc, for participating in the study. S.A.M. is a member of a speakers' bureau for Genentech and a consultant to Axcan Pharma and Novartis; T.H. is a consultant to Genentech; M.W.K. is a member of a speakers' bureau for Genentech and has received grant support from and is a consultant to Axcan Pharma, Digestive Care Inc, Genentech, and Novartis; and J.S.W. is a member of a speakers bureau for Genentech and is a consultant to Genentech and Novartis, and previously was an employee of Genentech. S.S. is an employee of ICON Clinical Research, which was paid by Genentech to provide biostatistical and analytical services for ESCF. No honoraria, grants, or other form of payment were given to any of these authors to produce this manuscript. The authors were responsible for the study design, interpretation of data, and drafting and completion of the manuscript. The initial draft and all subsequent drafts of the manuscript were written by Dr Schechter in consultation with the coauthors. The decision to submit the manuscript was made by the authors and was approved by Genentech.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
