ORCID Profile
0000-0002-7020-3239
Current Organisations
University of Tasmania
,
First Affiliated Hospital of Anhui Medical University
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Publisher: European Respiratory Society (ERS)
Date: 2022
DOI: 10.1183/23120541.00591-2021
Abstract: There are substantial advances in diagnosis and treatment for idiopathic pulmonary fibrosis (IPF), but without much evidence available on recent mortality and survival trends. A narrative synthesis approach was used to investigate the mortality trends, then meta-analyses for survival trends were carried out based on various time periods. Six studies reported the mortality data for IPF in 22 countries, and 62 studies (covering 63 307 patients from 20 countries) reported survival data for IPF. Age-standardised mortality for IPF varied from ∼0.5 to ∼12 per 100 000 population per year after year 2000. There were increased mortality trends for IPF in Australia, Brazil, Belgium, Canada, Czech Republic, Finland, France, Germany, Hungary, Italy, Lithuania, the Netherlands, Poland, Portugal, Spain, Sweden and UK, while Austria, Croatia, Denmark, Romania and the USA showed decreased mortality trends. The overall 3-year and 5-year cumulative survival rates (CSRs) were 61.8% (95% CI 58.7–64.9 I 2 =97.1%) and 45.6% (95% CI 41.5–49.7 I 2 =97.7%), respectively. Prior to 2010, the pooled 3-year CSR was 59.9% (95% CI 55.8–64.1 I 2 =95.8%), then not significantly (p=0.067) increased to 66.2% (95% CI 62.9–69.5 I 2 =92.6%) in the 2010s decade. After excluding three studies in which no patients received antifibrotics after year 2010, the pooled 3-year CSRs significantly (p=0.039) increased to 67.4% (95% CI 63.9–70.9 I 2 =93.1%) in the 2010s decade. IPF is a diagnosis associated with high mortality. There was no observed increasing survival trend for patients with IPF before year 2010, with then a switch to an improvement, which is probably multifactorial.
Publisher: Frontiers Media SA
Date: 11-04-2023
DOI: 10.3389/FMED.2023.1157706
Abstract: Immortal time bias (ITB) has been overlooked in idiopathic pulmonary fibrosis (IPF). We aimed to identify the presence of ITB in observational studies examining associations between antifibrotic therapy and survival in patients with IPF and illustrate how ITB may affect effect size estimates of those associations. Immortal time bias was identified in observational studies using the ITB Study Assessment Checklist. We used a simulation study to illustrate how ITB may affect effect size estimates of antifibrotic therapy on survival in patients with IPF based on four statistical techniques including time-fixed, exclusion, time-dependent and landmark methods. Of the 16 included IPF studies, ITB was detected in 14 studies, while there were insufficient data for assessment in two others. Our simulation study showed that use of time–fixed [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.47–0.64] and exclusion methods (HR 0.79, 95% CI 0.67–0.92) overestimated the effectiveness of antifibrotic therapy on survival in simulated subjects with IPF, in comparison of the time–dependent method (HR 0.93, 95% CI 0.79–1.09). The influence of ITB was mitigated using the 1 year landmark method (HR 0.69, 95% CI 0.58–0.81), compared to the time–fixed method. The effectiveness of antifibrotic therapy on survival in IPF can be overestimated in observational studies, if ITB is mishandled. This study adds to the evidence for addressing the influence of ITB in IPF and provides several recommendations to minimize ITB. Identifying the presence of ITB should be routinely considered in future IPF studies, with the time–dependent method being an optimal approach to minimize ITB.
Publisher: Wiley
Date: 11-07-2023
DOI: 10.1111/RESP.14552
Abstract: Little is known about the association between ambient air pollution and idiopathic pulmonary fibrosis (IPF) in areas with lower levels of exposure. We aimed to investigate the impact of air pollution on lung function and rapid progression of IPF in Australia. Participants were recruited from the Australian IPF Registry ( n = 570). The impact of air pollution on changes in lung function was assessed using linear mixed models and Cox regression was used to investigate the association with rapid progression. Median (25th–75th percentiles) annual fine particulate matter ( .5 μm, PM 2.5 ) and nitrogen dioxide (NO 2 ) were 6.8 (5.7, 7.9) μg/m 3 and 6.7 (4.9, 8.2) ppb, respectively. Compared to living more than 100 m from a major road, living within 100 m was associated with a 1.3% predicted/year (95% confidence interval [CI] −2.4 to −0.3) faster annual decline in diffusing capacity of the lungs for carbon monoxide (DLco). Each interquartile range (IQR) of 2.2 μg/m 3 increase in PM 2.5 was associated with a 0.9% predicted/year (95% CI −1.6 to −0.3) faster annual decline in DLco, while there was no association observed with NO 2 . There was also no association between air pollution and rapid progression of IPF. Living near a major road and increased PM 2.5 were both associated with an increased rate of annual decline in DLco. This study adds to the evidence supporting the negative effects of air pollution on lung function decline in people with IPF living at low‐level concentrations of exposure.
Publisher: Springer Science and Business Media LLC
Date: 26-12-2022
Location: China
No related grants have been discovered for Qiang Zheng.