Does Ethnicity Impact Access To CF Treatment?

It is no surprise that disparities in health care access have been present since the establishment of a health system. While these disparities are recognized, many reports continue to highlight the inequality that people of ethnic minorities face when navigating the health system. This is prevalent across all diseases, and encompasses many other factors such as sex, sexual orientation, immigration status, age, socioeconomic status, and religion.

A recent study published in Pediatric Pulmonology highlights that unequal access to CFTR modulators exists across various ethnic groups in America. It demonstrates that despite the recognition of disparities within the healthcare system, we still have a long ways to go in removing barriers to care in marginalized communities.¹

What are health disparities?

Health disparity, as defined by the National Institutes of Health, is "a significant disparity in the overall rate of disease incidence, prevalence, morbidity, or mortality in the specified population as compared with the general population."² Disparities are differences in care or outcomes, or inequality in health access.

Ethnicity and eligibility for CFTR therapy

The publication referenced above is a cross-sectional study that analyzed a cystic fibrosis (CF) patient registry in the United States. The authors assessed the percentage of racially-diverse patients who are eligible for CFTR therapy, based on the medications’ FDA-approved indications.

The study found that within each ethnic group, the percentage of patients who are eligible for disease-modifying therapies are:¹

• 92.4% of non-hispanic white patients
• 75.6% of hispanic patients
• 69.7% of African American patients
• 80.5% of other race patients

This data signifies that for various CFTR modulators marketed in the United States, African Americans were the least likely compared to any ethnicity to be eligible based on their mutations. In contrast, white patients were the most likely to be eligible for treatment. Overall, CF patients who are racially diverse are twice as likely to be ineligible for treatment. The issue is further complicated by the fact that ethnic cystic fibrosis patients are more likely to have more advanced CF and earlier onset of death compared to white patients.¹

Ethnic disparities in other areas of health care

Ethnic disparities are well documented within other spheres of health care. For example:

• African Americans are less likely than hispanic-whites to be referred for heart catheterization, a procedure which is used to diagnose and treat heart conditions³
• Minorities are less likely to seek mental health services and treatment⁴
• African Americans are less likely to achieve their cholesterol targets than white patients⁵
• African American women have worse ovarian cancer survival rates compared to white women, despite having similar cancer stages at diagnosis⁶

The solution

Reducing health care disparities requires a system reformation including addressing implicit biases. The key is to continue the conversation to raise awareness, as everyone deserves access to the same health outcomes.

Have you experienced any disparities in cystic fibrosis care due to your sex, age, religion, or ethnicity? Share your experiences below!