Social risk factors in patients with cystic fibrosis: impacts on exacerbations, lung function, and BMI

Cystic fibrosis (CF) outcomes are influenced by a myriad of genetic, microbiological, and environmental factors, as well as socioeconomic constraints. Studies have shown that low socioeconomic status is associated with a higher risk of death, lower body weight and height, worsened pulmonary function, and increased pulmonary exacerbation in children with CF. Screening for social risk factors (SRFs) is one possible approach to help mitigate unmet social needs in people with CF (PwCF).

Does a positive screening response for SRF correlate with health outcomes in PwCF?

This is a single-center, retrospective analysis of outcomes in adult PwCF. The study includes data from 2021 to 2022.

A social needs screening tool was administered to identify SRF in PwCF in eight domains: housing, food, transportation, utilities, healthcare cost, medication cost, income/employment, and education. A total of 121 PwCF were included in the analysis. Linear mixed-effects models, Poisson regression, and mixed-effects Cox regression were used for analyses of multivariate models.

When adjusted for multiple covariables, PwCF who screened positive for SRF had similar lung function and BMI as PwCF who reported no SRF and an increased CF exacerbation rates per person/per year when compared to their peers, 1.700 (1.275, 2.266) versus 0.829 (0.608, 1.130) (p = 0.006). Adjusted models showed that the median time to exacerbation was significantly lower in PwCF who screened positive for SRF (210 days vs 389 days).

PwCF who responded positively for SRF experienced an increased rate of CF exacerbation, and this finding remained significant when adjusted for multiple variables, including new CF medications. Medication cost, income/employment concerns, and food insecurity emerged as the most significant predictors of exacerbation rates and time to the next exacerbation. Further studies are needed to evaluate effective interventions and resources to mitigate SRF.