Researchers have discovered that the prevalence and incidence of idiopathic pulmonary fibrosis (IPF) among US veterans have risen over the last decade, according to a study published in Annals of American Thoracic Society.

In addition, the researchers found that the difference between veteran men and women in IPF prevalence was small (contradicting longstanding beliefs), with all other factors taken into account. The geographical distribution of cases was uneven, with rural areas recording higher incidences of IPF. 

Veteran medicine has increasingly come under the spotlight. This study is the first to investigate the epidemiological trends of IPF among the US veteran population. 


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The US Veterans Health Administration (VHA) provides a comprehensive nationwide network of care to US veterans, consisting of 130 hospitals and over 1000 community-based clinics. This provides a wealth of data on the health of US veterans. Since IPF is a disease that is known to have a higher prevalence among older men and given that 91% of US veterans are male with a mean age of 65, researchers of this study hypothesized that the prevalence of IPF may be higher among the US veteran population compared to the public. 

Researchers of this study analyzed data of electronic health records from US veterans who were enrolled in the VHA and had visited the inpatient or outpatient facility of a VA health center at least once between 2010 and 2019. Researchers then identified all patients who had an IPF diagnosis. 

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Patients who were diagnosed with IPF because of the absence of an alternative diagnosis were placed in the “broad case definition” group, while patients who had a corresponding CT thorax scan or a lung biopsy were put in the “narrow case definition” group. Data about age, sex, ethnicity, race, smoking history, residential area (urban or rural), and location of medical care were also recorded and analyzed. 

Results show 1.26% of IPF incidence in the “broad case definition” group, with the incidence rising from 141 cases per 100,000 population in 2010 to 331 cases per 100,000 in 2019. In the “narrow case definition” group, IPF incidence was 0.77% and cases rose from 73 cases per 100,000 population to 210 cases per 100,000 population in 2019. In summary, data analysis shows that both the prevalence and incidence of IPF among the US veteran population have risen significantly over the past decade. 

Risk factors among the US veteran population must also be taken into consideration. Researchers identified older age, white race, tobacco use, and rural residence as associated with increased risk of IPF.

“The rising incidence and prevalence of IPF among veterans are likely due to a combination of factors including increasing disease awareness and treatment motivation with the approval of antifibrotic therapies in 2014, an aging veteran population, and the implementation of low dose CT scans for lung cancer screening among smokers, which has been shown to detect incidental or subclinical pulmonary disease in up to 40% of veterans,” the authors of the study stated. 

The views expressed in the study do not necessarily correspond with that of the US Department of Veteran Affairs.

Reference

Kaul B, Lee JS, Zhang N, et al. Epidemiology of idiopathic pulmonary fibrosis among US veterans, 2010-2019. Ann Am Thorac Soc. Published online July 27, 2021. doi:10.1513/AnnalsATS.202103-295OC