Risk factors for diagnostic delay in idiopathic pulmonary fibrosis
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Risk factors for diagnostic delay in idiopathic pulmonary fibrosis. / Hoyer, Nils; Prior, Thomas Skovhus; Bendstrup, Elisabeth; Wilcke, Torgny; Shaker, Saher Burhan.
In: Respiratory research, Vol. 20, 103, 05.2019.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Risk factors for diagnostic delay in idiopathic pulmonary fibrosis
AU - Hoyer, Nils
AU - Prior, Thomas Skovhus
AU - Bendstrup, Elisabeth
AU - Wilcke, Torgny
AU - Shaker, Saher Burhan
PY - 2019/5
Y1 - 2019/5
N2 - Background: Surveys and retrospective studies of patients with idiopathic pulmonary fibrosis (IPF) have shown a significant diagnostic delay. However, the causes and risk factors for this delay are not known. Methods: Dates at six time points before the IPF diagnosis (onset of symptoms, first contact to a general practitioner, first hospital contact, referral to an interstitial lung disease (ILD) centre, first visit at an ILD centre, and final diagnosis) were recorded in a multicentre cohort of 204 incident IPF patients. Based on these dates, the delay was divided into specific patient-related and healthcare-related delays. Demographic and clinical data were used to determine risk factors for a prolonged delay, using multivariate negative binomial regression analysis. Results: The median diagnostic delay was 2.1 years (IQR: 0.9-5.0), mainly attributable to the patients, general practitioners and community hospitals. Male sex was a risk factor for patient delay (IRR: 3.84, 95% CI: 1.17-11.36, p = 0.006) and old age was a risk factor for healthcare delay (IRR: 1.03, 95% CI: 1.01-1.06, p = 0.004). The total delay was prolonged in previous users of inhalation therapy (IRR: 1.99, 95% CI: 1.40-2.88, p < 0.0001) but not in patients with airway obstruction. Misdiagnosis of respiratory symptoms was reported by 41% of all patients. Conclusion: Despite increased awareness of IPF, the diagnostic delay is still 2.1 years. Male sex, older age and treatment attempts for alternative diagnoses are risk factors for a delayed diagnosis of IPF. Efforts to reduce the diagnostic delay should focus on these risk factors. Trial registration: This study was registered at http://clinicaltrials.gov (NCT02772549) on May 10, 2016.
AB - Background: Surveys and retrospective studies of patients with idiopathic pulmonary fibrosis (IPF) have shown a significant diagnostic delay. However, the causes and risk factors for this delay are not known. Methods: Dates at six time points before the IPF diagnosis (onset of symptoms, first contact to a general practitioner, first hospital contact, referral to an interstitial lung disease (ILD) centre, first visit at an ILD centre, and final diagnosis) were recorded in a multicentre cohort of 204 incident IPF patients. Based on these dates, the delay was divided into specific patient-related and healthcare-related delays. Demographic and clinical data were used to determine risk factors for a prolonged delay, using multivariate negative binomial regression analysis. Results: The median diagnostic delay was 2.1 years (IQR: 0.9-5.0), mainly attributable to the patients, general practitioners and community hospitals. Male sex was a risk factor for patient delay (IRR: 3.84, 95% CI: 1.17-11.36, p = 0.006) and old age was a risk factor for healthcare delay (IRR: 1.03, 95% CI: 1.01-1.06, p = 0.004). The total delay was prolonged in previous users of inhalation therapy (IRR: 1.99, 95% CI: 1.40-2.88, p < 0.0001) but not in patients with airway obstruction. Misdiagnosis of respiratory symptoms was reported by 41% of all patients. Conclusion: Despite increased awareness of IPF, the diagnostic delay is still 2.1 years. Male sex, older age and treatment attempts for alternative diagnoses are risk factors for a delayed diagnosis of IPF. Efforts to reduce the diagnostic delay should focus on these risk factors. Trial registration: This study was registered at http://clinicaltrials.gov (NCT02772549) on May 10, 2016.
KW - Cohort
KW - Delay
KW - Diagnosis
KW - IPF
KW - Observational
U2 - 10.1186/s12931-019-1076-0
DO - 10.1186/s12931-019-1076-0
M3 - Journal article
C2 - 31126287
AN - SCOPUS:85066424337
VL - 20
JO - Respiratory Research (Print)
JF - Respiratory Research (Print)
SN - 1465-9921
M1 - 103
ER -
ID: 241355870