Educational inequalities in incidence and survival of idiopathic pulmonary fibrosis in Italy: a population-based cohort study

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Introduction or background: Idiopathic pulmonary fibrosis (IPF) is a rare disease with an unknown etiology. Aims and objectives: This study aimed to examine the role of educational level in the onset and survival of IPF in a population-based cohort. Methods: We used the Lazio Regional Longitudinal Study, i.e., the 2011 census cohort of residents in the Lazio region (central Italy) followed through administrative databases. We used the hospital discharge and the co-payment exemption registries to identify IPF cases. We followed IPF-free 25-90-year-olds from 1 January 2012 until the date of case identification, migration from the region, death, or 31 December 2022, whichever came first. We used age and sex-adjusted Cox models to study the association between educational level collected at the census and IPF onset and survival. Results: We analyzed 3,753,238 individuals. During the study period, we identified 3,213 new IPF cases (crude incidence rate 8.72 per 100,000, 95%CI:8.42-9.03), of whom 1,896 (59%) died. We found an inverse association between education and both IPF incidence and mortality. Taking account of age and sex, compared to those with a university degree, individuals with low education had a higher incidence (HR=1.35, 95%CI:1.18-1.54, in junior high, and HR=1.47, 95%CI:1.29-1.68, in primary school, respectively) and higher mortality (HR=1.31, 95%CI:1.08-1.59 in junior high and HR=1.39, 95%CI:1.16-1.66 in primary school, respectively). Conclusions: Low education represents a risk factor for developing IPF and an adverse prognostic factor for mortality.

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