Beyond borders: cystic fibrosis survival between Australia, Canada, France and New Zealand

BackgroundLife expectancy for people with cystic fibrosis (CF) varies considerably both within and between countries. The objective of this study was to compare survival among countries with single-payer healthcare systems while accounting for markers of disease severity.MethodsThis cohort study use...

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Bibliographic Details
Published in:Thorax Vol. 78; no. 3; pp. 242 - 248
Main Authors: Coriati, Adèle, Ma, Xiayi, Sykes, Jenna, Stanojevic, Sanja, Ruseckaite, Rasa, Lemonnier, Lydie, Dehillotte, Clémence, Tate, Jan, Byrnes, Catherine Ann, Bell, Scott C, Burgel, Pierre Regis, Stephenson, Anne L
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.03.2023
BMJ Publishing Group LTD
Subjects:
Accounting
Age
Aged
Australia - epidemiology
Body mass index
Canada - epidemiology
Cohort analysis
Cohort Studies
Cystic Fibrosis
France - epidemiology
Health care policy
Humans
International comparisons
Medical prognosis
Medical screening
Middle Aged
Mortality
Population
Registries
Statistical analysis
Thorax
Transplants & implants
Variables
Australia
France
Canada
New Zealand
United States > US
cystic fibrosis
ISSN:0040-6376, 1468-3296, 1468-3296
Online Access:Get full text
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Summary:BackgroundLife expectancy for people with cystic fibrosis (CF) varies considerably both within and between countries. The objective of this study was to compare survival among countries with single-payer healthcare systems while accounting for markers of disease severity.MethodsThis cohort study used data from established national CF registries in Australia, Canada, France and New Zealand from 2015 to 2019. Median age of survival for each of the four countries was estimated using the Kaplan-Meier method. A Cox proportional hazards model was used to compare risk of death between Canada, France and Australia after adjusting for prognostic factors. Due to low number of deaths, New Zealand was not included in final adjusted models.ResultsBetween 2015 and 2019, a total of 14 842 people (3537 Australia, 4434 Canada, 6411 France and 460 New Zealand) were included. The median age of survival was highest in France 65.9 years (95% CI: 59.8 to 76.0) versus 53.3 years (95% CI: 48.9 to 59.8) for Australia, 55.4 years (95% CI: 51.3 to 59.2) for Canada and 54.8 years (95% CI: 40.7 to not available) for New Zealand. After adjusting for individual-level factors, the risk of death was significantly higher in Canada (HR 1.85, 95% CI: 1.48 to 2.32; p<0.001) and Australia (HR 2.08, 95% CI: 1.64 to 2.64; p<0.001) versus France.InterpretationWe observed significantly higher survival in France compared with countries with single-payer healthcare systems. The median age of survival in France exceeded 60 years of age despite having the highest proportion of underweight patients which may be due to differences in availability of transplant.
Bibliography:Original research
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ISSN:0040-6376
1468-3296
1468-3296
DOI:10.1136/thorax-2022-219086