Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies

ABSTRACT

Introduction

Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions.

Areas covered

This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice.

Expert opinion

Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.

KEYWORDS:

• Cystic fibrosis
• respiratory outcomes
• social determinants of health
• social risk factors
• socioeconomic position

Article highlights

• Factors termed social determinants of health have both direct and indirect implications for CF health and contribute to the observed variability in CF respiratory outcomes.

• Structural social determinants that indirectly impact CF respiratory outcomes include social policies, socioeconomic position (income, education, occupation, health insurance), and race/ethnicity.

• Intermediate social determinants that directly affect CF respiratory outcomes include food, housing, and living conditions, environmental exposures (tobacco smoke, outdoor and indoor air quality, infectious agents), psychosocial factors (family structure, stress, social support), and health system factors.

• Multi-level strategies that address both structural and intermediary social determinants through policy, system, and environment changes are particularly needed.

• Interventions that can be adopted in clinical settings include screening for unmet social needs and referral to available resources, screening for smoke exposure and provision of tobacco treatment services, screening for and treatment of depression, and ensuring equitable access to care and representation in clinical trials.

Declaration of financial/other relationships

Gabriela R. Oates and Michael S. Schechter receive grant support from the Cystic Fibrosis Foundation and NIH

Michael S. Schechter receives consultancy fees from Vertex, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by grants from the National Institutes of Health (P30DK072482) and the CF Foundation (OATES20A0-I).