Annals of the American Thoracic Society最新文献

{"title":"Clinical and System-Level Factors Driving Donor Lung Utilization Decisions: A Qualitative Study.","authors":"Brittany Koons, James D Mendez, Michaela R Anderson, Edward Cantu, Matthew Hartwig, Christian Merlo, Krishna Pandya, Emily Vail, Jonathan P Singer, Jason D Christie","doi":"10.1513/AnnalsATS.202411-1175OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1175OC","url":null,"abstract":"<p><strong>Rationale: </strong>Key knowledge gaps exist in understanding what drives donor utilization decisions and contributes to the significant variability in organ offer acceptance rates. Defining and addressing the factors that explain variability in organ offer acceptance rates across United States (US) transplant centers is a key area of need.</p><p><strong>Objective: </strong>To identify the clinical and system-level factors that influence donor evaluation and graft acceptance decisions by lung transplant clinicians.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with lung transplant clinicians who actively participate in donor evaluation calls and make donor utilization decisions at a US transplant center between December 2022 and September 2023. Interviews were thematically analyzed.</p><p><strong>Results: </strong>From 12 interviews with lung transplant pulmonologists (n=6) and surgeons(n=6) across 8 different centers, we identified four main themes that represent distinct layers of influence on donor decision-making: 1) variability in donor factors considered acceptable for transplant (i.e., donor age, smoking history, oxygenation, imaging) and how to consider donation after cardiac death donor offers, 2) the complexity of matching critically ill and difficult-to-match (i.e., highly sensitized, rare blood type) candidates with offered organs, 3) the influence of provider training and experience on decision-making, and 4) the impact of multiple system factors including organ allocation, transplant center experience, resources, logistics, donor data availability, donor management strategies, and collaboration with organ procurement organization staff.</p><p><strong>Conclusions: </strong>Our findings offer insight into clinical practice variability, identify areas that may be improved by policy change, highlight opportunities to improve clinical training, and identify directions for future research.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of Peripheral Vasopressor Usage in an Academic Health System.","authors":"Daniel Shyu, Nicholas E Ingraham, Christopher A Linke, Lianne Siegel, Jared A Larson, Anna R Benson, Kathryn M Pendleton","doi":"10.1513/AnnalsATS.202411-1135OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1135OC","url":null,"abstract":"<p><strong>Rationale: </strong>Despite historical concerns for tissue injury from extravasation, studies suggest that peripheral administration of vasopressors is safe. However, peripheral vasopressor utilization remains variable.</p><p><strong>Objectives: </strong>To characterize the use of peripheral vasopressors over time, identify variability in use, and assess outcomes associated with their use.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients admitted to 10 hospitals in Minnesota (10/2020 - 10/2023) who received any vasopressors. Patients receiving vasopressors initially through a peripheral intravenous catheter were compared to those receiving vasopressors initially through central access. Safety, efficacy and utilization patterns across hospitals and providers were studied.</p><p><strong>Measurements and main results: </strong>9,493 total patients received vasopressors, including 3,734 with peripheral initiation and 5,759 with central initiation. 31 (0.8%) of the 3,734 patients with peripheral vasopressors received phentolamine for extravasation events, with one receiving a surgical consultation for tissue necrosis. Community hospitals had the highest utilization of peripheral vasopressors (50.7%), and academic medical centers had the lowest usage (27.6%). Initiation of vasopressors peripherally was not associated with increased hospital (aOR 0.87; 95% CI 0.78-0.97), 90-day (aOR 0.92; 95% CI 0.83-1.02), or 1 year mortality (aOR 1.0; 95% CI 0.91-1.11). Significant variation in use of peripheral vasopressors was observed across providers.</p><p><strong>Conclusions: </strong>Peripheral vasopressors were commonly and safely used in our 10-hospital health system, particularly in the community hospitals. Peripheral initiation of vasopressors was not associated with increased mortality at 90 days, but was associated with decreased hospital length of stay. Variation in peripheral vasopressor utilization was found across hospitals and providers.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Novel Shared Care Intervention to Address Obstructive Sleep Apnea in Rural West Virginia.","authors":"Robert Stansbury, Nicole Stout, Toni Rudisill, Judith Feinberg, Geri Dino, Sunil Sharma, Patrick J Strollo","doi":"10.1513/AnnalsATS.202410-1074OC","DOIUrl":"10.1513/AnnalsATS.202410-1074OC","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;There is a critical need to create sustainable interventions for the nearly 80% of patients with undiagnosed obstructive sleep apnea (OSA), particularly in rural communities where notable health disparities exist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective(s): &lt;/strong&gt;The objective of this study is to use implementation science and community engaged research methods to address OSA care disparity in West Virginia (WV) by designing an intervention to support primary care providers (PCPs) who treat patients in rural WV. Our overall project is grounded in context-sensitive approaches to address the unique challenges of OSA management in the rural primary care setting. Here we describe the pre-implementation work conducted to identify the determinants of implementation in rural settings and the selection of strategies that led to the initial program and will inform our prospective implementation effectiveness study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Veterans Affairs Quality and Enhancement and Research Initiative (QUERI) Implementation Roadmap to inform program development. Barriers and facilitators were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR) to inform our implementation plan. We derived ERIC strategies from the CFIR mapping exercise to identify the strategies that would improve implementation outcomes in rural primary care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Themes identified from our previous mixed methods community engagement study with PCPs were reviewed and mapped to CFIR domains and coded as implementation barriers or facilitators. Facilitators included provider recognition of the relative importance of OSA management, provider knowledge about OSA, and perceived patient receptivity to having a PCP evaluate and treat OSA. Predominant barriers included: PCPs' relatively low self-reported confidence in their ability to identify or manage OSA, challenges with clinical process and workflow that facilitate program adoption, and a relative lack of community-based resources or networks to support patients in such a program. One major barrier mapped to the CFIR domain \"inner setting\" was lack of clinical processes to support OSA screening, testing and referrals. The implementation strategy category that was identified to be most important for the OSA care program implementation was \"Develop stakeholder interrelationships.\" Other important strategy categories included \"Provide interactive assistance\" and \"Support for clinicians\" in the targeted rural communities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Leveraging a community-engaged approach and using implementation science informed the development and implementation of a novel OSA program to educate and support PCPs in OSA diagnosis and management that is tailored to the realities of rural primary care. This program, the West Virginia Obstructive Sleep Apnea Academic Mentoring Partnership, is well-positioned to address the care disparity for OSA in ","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of High-Flow Nasal Cannula and Conventional Oxygen Therapy for High-Risk Patients During Bronchoscopy Examination: A Multi-Center Randomized Controlled Trial.","authors":"Hao Qin, Jie Li, Jun Wang, Yu-Guang Yang, Guo-Qiang Jing, Rong-Zhang Chen, Wei Tan, Yong-Qi Zhang, Tian Li, Jun-Ci Yang, Bing Dai, Qin Wang, Yang Jiao, Yang Xia, Hai-Dong Huang, Qiang Li, Yu-Chao Dong, Chong Bai, Wei Zhang","doi":"10.1513/AnnalsATS.202410-1109OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1109OC","url":null,"abstract":"<p><strong>Rationale: </strong>Despite the increasing use of high-flow nasal cannula (HFNC) oxygen therapy during endoscopy examination, its impact on high-risk patients remains uncertain.</p><p><strong>Objectives: </strong>we aimed to compare HFNC and conventional oxygen therapy (COT) during nasal bronchoscopy in patients at high-risk for desaturation (morbid obesity, narrow trachea, or baseline hypoxemia and/or hypercapnia).</p><p><strong>Measurements: </strong>In this multicenter randomized controlled trial (RCT), patients scheduled for bronchoscopy and presenting with any high-risk factors were randomly assigned to receive HFNC or COT after providing written consent. Vital signs, pulse oximetry (SpO₂), and transcutaneous carbon dioxide (PtCO₂) were continuously monitored. The occurrence of desaturation (SpO₂≤90% lasted >10s), frequency of examination interruption and treatment escalation were compared between groups.</p><p><strong>Results: </strong>Of 148 initially enrolled patients, six withdrew, leaving 72 and 70 in the HFNC and COT groups, respectively. Most of the patients had airway stenosis. HFNC significantly reduced desaturation occurrence during bronchoscopy (34.7 vs. 61.4%, p=0.016), with fewer instances of examination interruption (26.4 vs. 58.6%, p<0.001) and less frequent treatment escalation (30.6 vs. 57.1%, p=0.001). During the examination, the lowest SpO₂ was higher with HFNC (94[IQR, 87-98] vs 87.5[79-93]%, p=0.001), while the highest PtCO₂ was lower (64.6[56.8-70.1] vs 68.3[62.3-77.0] mmHg, p=0.04). No significant differences were observed regarding the time to the first desaturation, bronchoscopy withdrawal, durations of desaturation and bronchoscopy examination, or occurrence of other adverse events between groups.</p><p><strong>Conclusions: </strong>In a high-risk population with predominantly airway stenosis, HFNC significantly reduced desaturation occurrence, examination interruption, and treatment escalation during nasal bronchoscopy examination in high-risk patients. Clinical trial registration available at www.ChiCTR.org.cn, ID: ChiCTR2100055038.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Tobacco Use Status among a National Cohort of Patients with COPD.","authors":"Alyssa Anton, Anne Melzer, Chris H Wendt, Ken M Kunisaki, R Adams Dudley, Arianne K Baldomero","doi":"10.1513/AnnalsATS.202406-659RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202406-659RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of an Overnight Stay at 2500 m on Nocturnal Hypoxemia and Sleep-disordered Breathing in Patients with Pulmonary Vascular Disease: A Randomized Trial.","authors":"Mona Lichtblau, Esther I Schwarz, Tanja Ulrich, Simon R Schneider, Meret Bauer, Michael Furian, Arcangelo Carta, Aglaia Forrer, Stéphanie Saxer, Julian Müller, Helga Preiss, Laura Mayer, Konrad E Bloch, Silvia Ulrich","doi":"10.1513/AnnalsATS.202412-1279OC","DOIUrl":"10.1513/AnnalsATS.202412-1279OC","url":null,"abstract":"<p><strong>Background: </strong>Patients with pulmonary vascular disease (PVD) often reveal nocturnal hypoxemia and sleep apnea. We investigated whether exposure to high altitude worsens those conditions.</p><p><strong>Methods: </strong>In a randomized-controlled crossover trial, stable patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) without resting hypoxemia (PaO2 >8 kPa at low altitude) underwent respiratory polygraphy at 470 m and during an overnight stay at 2500 m. Patients with severe hypoxemia (SpO2 <80 % for >30 min) at 2500 m received supplemental oxygen therapy (SOT) according to safety criteria. Main outcomes were the number of patients who did not require SOT, the effect of high altitude on nocturnal SpO2, oxygen desaturation index (ODI, ΔSpO2 of ≥3 %), apnea-hypopnea index (AHI) and the effect of SOT.</p><p><strong>Results: </strong>Of 27 patients (44 % women, 20/7 PAH/CTEPH, mean ± SD age 62 ± 14 y), 10 (37 %) required SOT during the course of the night (p=0.008 vs. low altitude). At 2500 m vs. 470 m, mean nocturnal SpO2 on ambient air decreased from 91 ± 2 % to 83 ± 4 % (mean change [95 %CI], -8 % [-9 to -6], p <0.001), time with SpO2 <90 % increased from 29 ± 27 % to 92 ± 15 % (+63 % [30 to 92], p <0.001), the ODI increased from 17 ± 14 /h to 42 ± 26 /h (+24.8 /h [12.8 to 36.5], p <0.001) but AHI remained unchanged. With SOT SpO2 was restored to values at 470 m.</p><p><strong>Conclusions: </strong>In stable, low-risk patients with PVD, altitude worsened nocturnal hypoxemia but not sleep-disordered breathing. The majority of patients did not require SOT according to predefined safety criteria. When needed, SOT restored low altitude indices of oxygenation. Clinical Trial registration available at www.</p><p><strong>Clinicaltrials: </strong>gov NCT05089487.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eliciting Patient Preferences for Pragmatic Critical Care Trials: Qualitative Study.","authors":"Jessica A Palakshappa, Megan L Rischall, Ashley E Strahley, Alexa E Cecil, Matthew E Prekker, Brian E Driver, Brianna H Denny, Kevin W Gibbs","doi":"10.1513/AnnalsATS.202410-1122OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1122OC","url":null,"abstract":"<p><strong>Rationale: </strong>Conducting pragmatic comparative effectiveness trials in critically ill populations poses distinct challenges. Knowledge gaps exist in how to best conduct pragmatic research while demonstrating respect for critically ill patients and their families.</p><p><strong>Objective: </strong>To engage patients with lived critical care experience to elicit their perspectives on 1) decisions related to the design and conduct of pragmatic comparative effectiveness trials in the in acute and critical care settings, and 2) subsequent notification of pragmatic trial participation.</p><p><strong>Methods: </strong>We conducted a qualitative research study using the principles of reflexive thematic analysis. An interview guide was developed by the investigators with expertise in qualitative methodology, critical care, emergency medicine, and pragmatic comparative effectiveness trials; this guide used two research study examples to elicit feedback from participants. Using a purposive sampling technique to ensure the inclusion of diverse perspectives, we recruited a convenience sample of patients from two hospitals during a hospitalization for a critical illness or injury. Interviews with participants were conducted via telephone after discharge, audio recorded, and transcribed verbatim. A codebook was developed inductively, and coding was performed in duplicate. Emerging themes were reviewed and validated with the larger research team.</p><p><strong>Results: </strong>A total of 20 interviews were completed and saturation was achieved. Findings were organized into four themes: (1) Trust and past care experiences influence patient receptivity to pragmatic comparative effectiveness research; (2) Familiarity with research influences patient comfort and willingness to participate; (3) Altruism and a desire to contribute to research knowledge motivate patient participation in research; (4) The experience of critical illness influences patient receptivity to the research process.</p><p><strong>Conclusions: </strong>Patients with a lived experience of critical illness are generally supportive of pragmatic comparativeness effectiveness trials in the emergency or critical care setting. The factors influencing patient receptivity identified in this study highlight opportunities for investigators, healthcare leaders, and regulators to better align with patients in future design and conduct of pragmatic comparative effectiveness trials.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poor People of Color Breathe Poor Air.","authors":"John R Balmes","doi":"10.1513/AnnalsATS.202503-258ED","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202503-258ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Outcomes in Pi*MZ Alpha-1 Antitrypsin Deficient Individuals with Tobacco Smoking History from the SPIROMICS Cohort.","authors":"Igor Barjaktarevic, Roxana Hixson, Zian Zhuang, Russell G Buhr, Vickram Tejwani, R Graham Barr, Lori A Bateman, Surya P Bhatt, Eugene R Bleecker, Christopher B Cooper, Jeffrey L Curtis, M Bradley Drummond, Spyridon Fortis, Auyon J Ghosh, MeiLan Han, Nadia N Hansel, Eric A Hoffman, Jill Ohar, Fernando J Martinez, Deborah A Meyers, Robert Paine, Cheryl S Pirozzi, Robert Sandhaus, Charlie Strange, Donald P Tashkin, J Michael Wells, Prescott Woodruff, Victor E Ortega","doi":"10.1513/AnnalsATS.202411-1209OC","DOIUrl":"10.1513/AnnalsATS.202411-1209OC","url":null,"abstract":"<p><strong>Background: </strong>Reliable data about the natural history of lung function decline in alpha-1 antitrypsin (AAT) deficient Pi*MZ heterozygotes is largely missing. We hypothesized that, in adults with a tobacco smoking history, lung function deteriorates faster in Pi*MZ compared to Pi*MM genotype.</p><p><strong>Methods: </strong>We identified 1856 Pi*MM and 79 Pi*MZ participants with ≥20 pack-years tobacco smoking history from the SPIROMICS cohort by DNA sequencing and followed them over a median of 4.8 years, comparing radiographic and clinical characteristics between the two groups over time using regression models.</p><p><strong>Results: </strong>Adjusted for age, sex, race, smoking pack-year history and smoking status, Pi*MZ participants had a lower baseline percent-predicted FEV1 (65.4% vs. 75.1%, difference 95% CI: -15.4%, -3.9%), more radiographic emphysema (<-950HU%: 12.9% vs. 7.8%, difference 95% CI: 2.8%, 7.5%) and non-significantly lower lung density. In the longitudinal analysis, the FEV1 annual rate of decline was similar in both groups over the course of the study (-34.5mL/year vs. -34.6mL/year for Pi*MZ and Pi*MM, difference 95%CI: -16.9,17.1mL/year). There were no significant differences between Pi*MZ and Pi*MM individuals in the annualized change in lung density, emphysema, patient-reported outcomes, exacerbations or survival. The proportion with faster FEV1 decline (annual loss ≥40mL) was similar in Pi*MZ and Pi*MM groups. In both groups, faster FEV1 decline was associated with more air trapping and small airway disease at baseline. In Pi*MZ only, faster decline was associated with higher blood eosinophil counts (310 vs. 220 cells/µL, difference 95% CI: 30, 140 cells/µL). In the subgroup analysis limited to a small number of, currently smoking participants, no significant differences in longitudinal outcomes were found.</p><p><strong>Conclusion: </strong>Despite a lower FEV1 and more emphysema at enrollment, the longitudinal analysis did not demonstrate significantly greater lung function decline or lung density loss in Pi*MZ compared to Pi*MM participants with tobacco smoking history. Limited sample size and duration of longitudinal follow up constrain generalizability of our findings, thus prohibiting the conclusion that longitudinal trajectories did not differ between these groups. However, our results may suggest that earlier life events could be responsible for more extensive lung disease at enrollment in Pi*MZ compared to Pi*MM tobacco-exposed individuals.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Prevalence, and Mortality of Interstitial Lung Diseases in Alberta, Canada: A Population-based Study.","authors":"Kerri A Johannson, Zhaoyu Liu, Danielle A Southern, Meena Kalluri, Andrea S Gershon, Erica Farrand, Amanda Grant-Orser, Jolene H Fisher","doi":"10.1513/AnnalsATS.202406-625OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202406-625OC","url":null,"abstract":"<p><p>Background The epidemiology of adult interstitial lung disease (ILD) is uncertain, given heterogeneous estimates from prior studies. The objective of this study was to define the incidence, prevalence, and mortality of ILD over a 10-year period using population-based data. Methods We created an administrative ILD cohort in Alberta, Canada between 2010-2019 using population-based administrative data (inpatient, ambulatory, and outpatient physician billing databases) for a repeat cross-sectional study. Case definitions were developed from an established ILD cohort and applied to the general population, with performance characteristics tested using a nested case-control design. Age-and sex-standardized annual incidence and point prevalence rates were estimated for ILD overall and within diagnostic sub-groups, with trends over time, per 100,000 at-risk adults and to permit comparisons with other studies, per 100,000 total population. Cox models estimated risk of death or lung transplantation. Results Between 2010-2019, 31,492 incident and 42,549 prevalent adult ILD cases were identified. The case definition for ILD performed well with 96.8% sensitivity, 98.5% specificity, and positive predictive value 94.3% in the population cohort. Mean age-standardized ILD incidence was 107.9/100,000 at-risk adults, 90.9/100,000 for females and 129.1/100,000 for males. Age-standardized ILD point prevalence increased from 416.5/100,000 at-risk adults in 2010 to 789.7/100,000 in 2019, higher in males vs females, and in rural vs urban areas. Age-standardized mean idiopathic pulmonary fibrosis (IPF) incidence was 36.9/100,000 at-risk and point prevalence was 205.3/100,000 at-risk in 2019. Mean age-standardized ILD incidence and prevalence was 84 and 516.9/100,000 total population, respectively. One-year all-cause mortality for ILD patients decreased from 14.5% in 2011 to 11.7% in 2018 (adjusted rate ratio (RR) for 2018 vs 2011, 0.76; 95%CI 0.67-0.86). One-year all-cause mortality for IPF similarly decreased from 20.9% in 2011 to 14.7% in 2018 (adjusted RR for 2018 vs 2011, 0.71; 95%CI 0.59-0.85), representing improved survival. Conclusions In this population-based cohort, claims-based case definitions derived from a established ILD cohort performed well to develop an administrative cohort. Incidence remained stable over time, while prevalence increased and mortality decreased, for ILD overall and within the IPF subgroup. These estimates are higher than most prior reports, suggesting an overall underestimate of ILD burden.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}