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The natural history of idiopathic pulmonary fibrosis in a large European population: the role of age, sex and comorbidities

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Abstract

Placebo arms of clinical trials provide an opportunity to investigate the natural history of idiopathic pulmonary fibrosis (IPF) but these patients are not representative of the real life IPF population. Objective of this article is to evaluate patients’ characteristics of incident IPF cases and their impact on mortality and hospitalizations risk. We conducted a retrospective cohort study using data from administrative databases from 2000 to 2010. Based on different algorithms reported in literature, incident IPF cases were identified. We applied Cox proportional hazards models to assess relationship between patients’ characteristics, mortality and hospitalization. According to three case definitions, we identified 2338, 460 and 1704 incident IPF cases. Mean age at diagnosis was about 72 years, the proportion of male varied between 59 and 62% and patients with at least one chronic disease were between 70 and 74%. Age, male sex and comorbidities were associated to worse outcomes. Congestive heart failure (CHF), diabetes and cancer were conditions associated to mortality, while those associated to hospitalization were CHF and chronic obstructive pulmonary disease. Our data source provided one of the largest samples of unselected patients with a long follow-up period. Using different algorithms proposed and validated in literature, we observed that mortality and hospitalization rate are high in patients with IPF and age, sex and comorbidities significantly affect clinical outcomes. Females show a significant survival advantage over males, even after adjusting for age and comorbidities. Patients with pre-existing diseases, especially those with pulmonary and cardiovascular diseases are at higher risk.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. A. Caminati and F. Madotto equal contribution—share first authorship

Authors and Affiliations

  1. U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, MI, Italy

    Antonella Caminati & Sergio Harari

  2. Value-based Healthcare Unit, IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy

    Fabiana Madotto & Lorenzo Mantovani

  3. Research Centre on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Monza e Brianza, Italy

    Fabiana Madotto, Sara Conti, Giancarlo Cesana & Lorenzo Mantovani

  4. Clinica Medica, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Sergio Harari

  5. Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy

    Sergio Harari

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  1. Antonella Caminati
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  2. Fabiana Madotto
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  3. Sara Conti
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  4. Giancarlo Cesana
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Correspondence to Antonella Caminati.

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AC reports personal fees from Roche and Boehringer Ingelheim. FM, SC, GCC and LM have nothing to declare. SH reports personal fees from Roche, Actelion and Boehringer Ingelheim.

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Caminati, A., Madotto, F., Conti, S. et al. The natural history of idiopathic pulmonary fibrosis in a large European population: the role of age, sex and comorbidities. Intern Emerg Med 16, 1793–1802 (2021). https://doi.org/10.1007/s11739-021-02651-w

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  • DOI: https://doi.org/10.1007/s11739-021-02651-w

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