Annals of the American Thoracic Society最新文献

Rationale: Examining lung cancer mortality trends at the county level would better inform our understanding of racial, ethnic, and geographic differences in the United States. Objectives: To analyze lung cancer mortality trends by race and/or ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Latino, and White), sex, and county. Methods: Data from the National Vital Statistics System and National Center for Health Statistics (2000-2019) were used to estimate age-standardized lung cancer mortality in 3,110 counties, adjusted for misclassification. Results: From 2000 to 2019, lung cancer mortality decreased from 68.3 (95% uncertainty interval, 67.9-68.7) to 42.5 (42.3-42.8) deaths per 100,000. Males experienced a larger decrease (44.8%) than females (29.4%). Similar patterns were observed at the county level, with considerable geographic variation within and across racial and/or ethnic populations. In 2019, higher rates among Black and White populations were observed in the Mississippi River watershed and Appalachia and in AIAN populations in the upper Midwest, Northeast, North Carolina, Oklahoma, and Kansas. From 2000 to 2019, for males and females combined, lung cancer mortality rates increased in 57 counties (12.0%) for the AIAN population, with a median increase of 7.5 deaths per 100,000. Increases in counties were less common among Asian (n = 36, 5.4%), Latino (n = 36, 2.4%), and White (n = 1) populations, whereas no county showed an increase for Black individuals. Conclusions: Despite marked reductions in lung cancer mortality, geographic and racial and/or ethnic differences persist, which emphasizes the need for targeted interventions to further improve lung cancer outcomes for all populations.

Rationale: Clustering of social and environmental risks in low-income neighborhoods is a key factor in racial and ethnic asthma disparities. Integrating school and in-home programs, with treatment tailored to disease risk, is a promising approach for children with high disease burden. Objectives: We evaluated the Rhode Island Asthma Integrated Response (RI-AIR) program in improving asthma outcomes at the individual and community levels. RI-AIR leverages existing community collaborations and technological advances to identify children with asthma at the highest risk for poor outcomes through a system of identification, screening, and intervention. Methods: We conducted a stepped wedge cluster randomized hybrid type II effectiveness-implementation study. School-based catchment areas (N = 32) of high asthma burden were identified using geospatial mapping of asthma-related urgent healthcare use from 2010 through 2018. Families received only school-based interventions if the child's asthma was categorized as "not well controlled" or school- and home-based interventions if the child's asthma was deemed "poorly controlled." Community health workers facilitated communication between families, schools, and healthcare providers. Follow up visits occurred every 3 months to 1 year after the intervention. Results: Individual level: At 3 months, asthma control (primary outcome) improved (d = 0.47; 95% confidence interval, 0.33-0.61) and symptom-free days increased (d = 0.37; 0.24-0.51); both improvements were sustained at 12 months. Community level: healthcare use remained the same or increased (rate ratio, 1.16; 1.00-1.36); however, sensitivity analyses indicated that healthcare use was slightly lower in areas with greater family participation (i.e., penetration; active intervention, 0.93 [0.87-0.99]; postintervention, 0.91 [0.86-0.97]). Conclusions: Intensive, multicomponent interventions and community engagement are needed to improve asthma outcomes in areas of high burden. Clinical trial registered with www.clinicaltrials.gov (NCT03583814).

Rationale: Elexacaftor/tezacaftor/ivacaftor (ETI) provided substantial health benefits to children with cystic fibrosis (CF) in clinical trials; there is less information about its effectiveness in a "real world" setting. Objectives: The aim of the PROMISE (A Prospective Study to Evaluate Biological and Clinical Effects of Significantly Corrected CFTR Function) Pediatric substudy is to determine the long-term (four years) impact of clinically prescribed ETI among children 6-11 years of age at enrollment. The primary outcome measure is the lung clearance index at a 2.5% (LCI_2.5). Methods: The PROMISE Pediatric substudy enrolled children with CF 6 to <12 years of age starting ETI. Outcomes measured at baseline (before ETI) and 1, 3, 6, and 12 months after ETI initiation included LCI_2.5, percentage predicted forced expiratory volume in 1 second, Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory domain symptom score, height, weight, oropharyngeal cultures, and culture and deoxyribonucleic acid-based analysis of sputum microbiology (when sputum was available). Sweat chloride was assessed at baseline and at 1 and 6 months. Results: One hundred twenty-five participants were enrolled at 20 U.S. CF centers. Lung function improvement after ETI initiation was rapid and sustained through 12 months, with a mean decrease in LCI_2.5 of -0.79 (95% confidence interval [CI], -1.04 to 0.55) and a mean increase in percentage predicted forced expiratory volume in 1 second of 5.6% (95% CI, 3.4% to 7.7%). Respiratory symptoms also diminished significantly (mean change in CFQ-R respiratory domain symptom score, 4.1 [95% CI, 1.94 to 6.24]). Sweat chloride decreased significantly at 6 months (mean change, -47.2 mmol/L [95% CI, -51.99 to -43.8 mmol/L]). Weight, body mass index, and height z-scores were not different from baseline at 12 months. Staphylococcus aureus prevalence in oropharyngeal or sputum cultures did not change, but its density in sputum cultures decreased a mean of 1.47 log₁₀ colony-forming units/g (95% CI, -2.37 to -0.58 colony-forming units/g) at 12 months. Conclusions: Initiation of ETI in a real-world setting was associated with clinically significant improvements in lung function and symptoms and decreased S. aureus sputum density at one year; lung function improvements were smaller than those reported in clinical trials. Clinical trial registered with www.clinicaltrials.gov (NCT04038047).