Schechter and colleagues sought to determine whether previously reported socioeconomic status (SES)-related disparities in cystic fibrosis (CF) health outcomes vary by (a) the indicator used (median household income by zip code [MIZ]; (b) maternal educational attainment [MEA] and state insurance coverage [MA]); and (c) whether these disparities can be explained by differences in medical treatment. A cross-sectional analysis was conducted of data on patients age <18 years from the Epidemiologic Study of Cystic Fibrosis (ESCF). Disease severity showed a similar inverse correlation with all three SES measures. The number of stable clinic visits was unrelated to SES. Patients with MA had sicker outpatient visits and more courses of intravenous (IV) antibiotics for pulmonary exacerbations, and were more likely to be prescribed all chronic therapies. Low-MIZ patients had slightly fewer sick visits and more courses of IV antibiotics, and were more likely to receive oral nutrition supplements but less likely to receive macrolide prescriptions. Low-MEA patients were less likely to receive IV antibiotics at home, more likely to receive oral nutrition supplements, but less likely to receive macrolide prescriptions.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that CF health outcomes are correlated with the SES spectrum, but these disparities are not explained by differential use of health services or prescription of chronic therapy. Future investigations should focus on the possible impact of environmental exposures and differences in disease self-management.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Self-management training must be a staple in the control of CF in all patients. As noted in this study, however, this goal may be hard to achieve in many patients because of differences in SES and other variables.

MS Schechter et al. Association of Socioeconomic Status with the Use of Chronic Therapies and Healthcare Utilization in Children with Cystic Fibrosis. Journal of Pediatrics, July 14, 2009.